bb^b'] <br />SCANNE Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugeni, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:------- <br />Map and Tax Lot — <br />Building Type: ■ SFD □ Duplex □ Multi—Family □ Commercial □ Industrial <br />O&Xl <br />Owner 0<\J <br />Permit Information <br />Permit No. I ^ <br />nnntrnntnry'Pliimhpr ACk-b (x>^T_Pipe Material__$Ot —Pipe DiameterJd— <br />□ System Development Charge <br />Inspected By L-lO^rb ___ <br />ccMyctkn to pub/fc mmt h conformnonc* to Oty ttandardo and •poctlkationt. <br />Date of Issue <br />□ Right of Way Cut Permit Required <br />Installation Date *' / 13 / ----------- <br />Patmho/on grantod to oitocfi prhoto <br />Public Wastewater Information <br />Index Page No. <br />Inspected By <br />HMIg r7UT7 <br />Upstream <br />57 Segment No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />A <br />TT e-T'-T''? <br />I <br />I <br />I <br />Ia VI O ' <br />nmi