!» <br />9 <br />ii <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection SCANNE 1820 Roosevelt Blvd. <br />Eugeni, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot—: <br />Building Type: <br />I3 '9Li \AATf Sf <br />Owner ..Pa.'J Sjp/C''.______ <br />yfSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. I 9 03 )^3 ~ ^ l________Date of Issue "J 3 ~19 // <br />Contrantor/Plnmhfir PcyT\C^- PipR MntftrinlBO^^^Scio^Opipf. Diameterill(_ <br />□ Right of Way Cut Permit Required <br />Installation Date ___~ -- ^ ^ i______ <br />□ System Development Charge <br />Inspected By <br />PwmMaf grant*/ to attach pttoot* —vtr con/HcVon to piMk mtwtr h confotmnanct to Oty ttarxfarxtt and tptcftfcation*. <br />Public Wastewater Information <br />Index Page No <br />Insp^gdByC733Segment No.Contract No.Upstream Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />\n <br />ai <br />'di <br />t <br />i <br />l <br />i i <br />jIr"I <br />n• / <br />-r 9^ <br />iP. a B. <br />\ ■ <br />. V1 .