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I; bb^o <br />i SCM/Ne 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: ^-SFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />1520 A\Jt <br />Owner <br />Permit Information <br />Permit No. \ OH5^57 ~Q 1 <br />Contractor/Plumber <br />□ Right of Way Cut Permit Required <br />Installation Date ___i ~^ ~ * 1_____ <br />Date of Issue ~7~ H ~ 1 <br />Pipe Mntftrinl bjC.Y\MO Pipe Diameterili. <br />□ System Development Charge <br />Inspected By L<a.Oo.££<£._________ <br />PwmJmkti granted to attach prfxri* mmr connrctioa to pubUc mmr h confermnonc* to Oty ttandardu and tp^cHkaikma. <br />'I <br />Public Wastewater Information <br />Index Page No— <br />mis nlnspect^iL‘J <br />Segment No.-1 Contract No.Upstrcom Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />Av'<2*o/£/\#331^\ <br />I <br />ft is 5^^ 3 <br />I <br />. I .