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if., <br />■f ■h <br />i <br />Public Works <br />Maintenance <br />SCAMMFffg <br />Location of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />EugenO, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address _____:__ <br />Map and Tax Lot_: <br />Building Type: □ Duplex □ Multi-Family □ Commercial □ Industrial <br />33£0 DevoS S'h <br />Owner LoKe. ario Oervise Sa\)<xf <br />Permit Information <br />Permit No. <br />Contractor/Plumber.C R_____ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Pwmhtion granhd to attodi ptfcrtw <br />1^-076,43-01 Date of Issue /O 'Q- Iff /, ,, <br />Pipe Mntfirinl SC K (fO/o03^Pipf» Diameter_/_^_^ <br />□ System Development Charge <br />\ Q-Coi^seInspected By <br />*» conformnanc* to CXy ttandanit andconn*ctk*) to pubOc <br />Public Wastewater Information <br />Index Page No.^Se^ent No..Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-23+4 <br />K-9 ; <br />s' <br />I <br />3i4 <br />4"Vg <br />90’ <br />V' <br />i / <br /><o H9' <br />>ne.VOS 5t. <br />, ?