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bbmn •i <br />gCANNEC®Public Works <br />MaintenanceLocation of <br />Wastewater Connectio 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 />6anjy Dr. <br />r] ArAy Hr. Iiaynf <br />^LSFD □ Duplex □ Multi-^-Family □ Commercial □ Industrial <br />Owner LiZ-ft'n <br />Permit Information <br />Permit No. I ci ' CD i7 ' O I <br />r.nntrnntnr/PlumhRr PloWb/n^Pjpe Material <br />□ Right of Way Cut Permit Required <br />q-iq-iq <br />Date of Issue ~ / 9~/9 //4Pipe Diameter. <br />□ System Development Charge <br />L-etC*Inspected ByInstallation Date <br />Pwmhthn to attach prM* *~rT eowcffoa to pobOc »—w h ccnformnanc* to CHy rtandacdm and $p*cMartfont. <br />Public Wastewater Information <br />Index Page No., <br />Inspected B <br />Upstream31Segment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />u <br />HT-/ <br />6 rone-B1 T <br />Y\askc •L. <br />4-o <br />Cone.7^~X) <br />£ <br />^0 <br />i <br />4