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fr!, <br />i <br />SCANNt ©Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address • ' • ' <br />Map and Tax Lot__ <br />Building Type: <br />3^50 6abern<S.‘i~ Ln. <br />Owner <br />^TSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. \ S ~ OO H ^ l ________ <br />Contractor/Plumber. ^ __Pipe Mntftrinl 3ch- HO <br />□ Right of Way Cut Permit Required <br />Installation Date __3 ~ 13 ~ l ^ <br />rwmhthn grant'd to atiocfi prtmi* <br />\^\-iqDate of Issue <br />HPipe Diameter. <br />□ System Development Charge <br />Lg CalSCInspected By <br />It canformnanct to Oty ttandarrii and wptcflkxrthns.confection to pubOc <br />Public Wastewater Information <br />Index Page No. <br />Inspected By . <br />Downstream <br />yj Segment No.-l^j^ <br />Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />L <br />Cr <br />^7^ <br />zVg/o'_o <br />u <br />3 <br />o 4 is 4' detf <br />/ <br />3H'3/