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if-:. <br />i <br />i <br />Public Works <br />MaintenancecSCANNEC©Location of <br />Wastewater Connect!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 />Pniie. u> <br />---------------------------------Owner CV\r<.T P>r<XU!f) <br />D □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. _ <br />Contractor/Plumber <br />Date of Issue 3Q~ ) *7 <br />Pipe Mntftrinl Sc^MO Pipe DiameterZI <br />n <br />□ Right of Way Cut Permit Required <br />Installation Date —£> '3 i ~ ) -------- <br />□ System Development Charge <br />Inspected By <br />*i can/ormnonc* to Oty Handardt and •ptctlfccikns.cermocVom to pubUePmnMcn mt»d to aitocit prhot* <br />Public Wastewater Information <br />Index Page No-----£ <br />Inspected By _ <br />Segment No. ----------%(n Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-BOO-332-2344 <br />.,vA <br />4 <br />MO" <br />« <br />H <br />\,h 13 3'