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Public Works <br />MaintenanceLocation of <br />Wastewater Connection SCANNE 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />•f <br />Property Information <br />Address -------:------- <br />Map and Tax Lot — <br />Building Type: fi SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner CLX- <br />Permit Information <br />Permit No. <br />A&S Pipe Diameter, . <br />aa^kt <br />Contractor/Plumber .V^V\AS Tiwbpipe <br />□ Right of Way Cut Permit Required <br />Installation Date 12^27 j --------- <br />Date of Issue <br />Material. <br />□ System Development <br />Inspected By V- iQN <br />connection to public •ewer h conformnonce to CXy itandorde andPermhehn granted to attach private <br />Public Wastewater Information <br />Index Page No—U-& <br />Inspected By <br />S7.TS ^27 MSegment No.- Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />052-1S 0 l •y i <br />S2.1H <br />\ <br />J>7