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i <br />Public Works <br />MaintenanceLocation of <br />Wastewater Connection SCANN 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address ■ <br />Map and Tax Lot— <br />Building Type: £^SFD <br />7%% ^Ty^on Ln <br />Home C <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Owner <br />Permit Information <br />Permit No. <br />Contractor/Plumber.S.and ^ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />Ptmhthn grxwiM to attocti prtvato <br />Date of Issue /<^~~7 /{? <br />Pipe Material Sc h • H O Pipe Diameter^ <br />□ System Development Charge <br />Inspected By LolC^ciSSCL.__________ <br />11 <br />kt ccnformnooco to Ctty rtandcrdm and tpodlkatkx*. <br />Public Wastewater Information <br />Index Page No—2H <br />_ Inspected By — <br />gSOO£> Tlznn'r <br />Upstream DownstreamSegment No..Contract No. <br />TWO WORKING DAYS BEFORE YOU DIG. CALL UTILITY ONE-CALL SERVICE AT 1-800-332-23+4 <br />3' <br />Publfd0 <br />OtF <br />3^ <br />i <br />1 l <br />y'H <br />'H