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bb'b'S'Ts- <br />>1 ■ __________t SCANNER Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address _______lyf£>n Ln. <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Map and Tax Lot-----: <br />Building Type: <br />Owner <br />Permit Information <br />Permit No. \C\' Q\ 103 ~ ^ ( _____ <br />Contrantor/Plumhfir -5nnrl M LoQ nr\ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />/Vm4—fan granftd to attach prtvata <br />Date of Issue // <br />Pipe Material Sch. HO__Ripe Diameter-3 <br />□ System Development ChargeM-S-iq Inspected By <br />h conformnanc* to Ctty rtandan* and •pKhkatfon*connection to pubtfc <br />Public Wastewater Information <br />Index Page No— <br />^ Inspected By _ <br />yyDQi <br />dpstrcom DownstreamSegment No.Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTTUTY ONE-CALL SERVICE AT 1-800-332-2344 <br />Ln. <br />I I4c2I6 <br />/ <br />’0 <br />ff,S <br />0 0 <br />Ve/ <br />3 <br />5^'I <br />I <br />. i