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zbMlo <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection SCANNE 1820 Roosevelt Blvd. <br />EugenC, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ____:____ <br />Map and Tax Lot — <br />Building Type: 0 SFD □ Duplex □ Multi—Family □ Commercial □ Industrial <br />\\*to A\)£ <br />Owner <br />Permit Information <br />Permit No. \C\~ Q~l <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />\Q I 7 / \^\ <br />\o/n\wDate of Issue <br />Pipe Material../-L. <br />k <br />Pipe Diameter. <br />□ System Development Chan <br />Inspected By '—-A /'_1Installation Date <br />PwmMon granted to aitoch pfMrt* —w eorwetfew to poMc ••wtr h conform/Kinc* la Oty atandordi and <br />Public Wastewater nformation <br />Index Page No.—U-O-L— Segment No— <br />Inspected By <br />Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />0 <br />I’4/z1/1 \d-2'■ <br />- -(i- <br />5'Ni <br />4-7- <br />K <br />'V <br />m' <br />i <br />0- 5151 <br />w nTri