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l?b'y'^L1' <br />4 <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connectio SCANNE 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 />Aye.s Hayrlevn <br />^IrSFD □ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No.__j <br />Contractor/Plumber. <br />□ Right of Way Cut Permit Required <br />Installation Date _____f/ *3 " ) i <br />rwmhtlon aranttd to attach prtvata <br />_______i__________Date of Issue 3 lot @1 <br />rv4 h .L c<L ’A'"':—Pipe Material .^C,^. Pipe Diameter ^ <br />iq-OQR-QI > icO n <br />□ System Development Charge <br />l~a C, a$.Inspected By <br />h conformnanco to Ctty rtamfarxh and tpadtkaHont.connactkn to potOc <br />Public Wastewater Information <br />Index Page No. <br />|nspecked By <br />2^Segment No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTIUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />N <br />L <br />7’ <br />5B) v? <br />S> ptf is <br />II' <br />t» <br />iaor—> <br />Ave.on <br />. i