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r ••h <br />i 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 ______ <br />Map and Tax Lot------ <br />Building Type: ^HsFD <br />^7? /y.5on Lyi , <br />j-kyrlt^n Honnf c_______________________Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No._____________________________ <br />Contractor/Plumber ^ M. .Lpa.yip <br />□ Right of Way Cut Permit Required <br />Installation Date __b ~ b' I 3. <br />PwmMt/on granM to attach pttntm <br />\c\-Q2GK\b-0\Date of Issue H 30 ~ / 9 <br />Pipe Material <br />'/ <br />DiametemiSrU.HQ Pipe <br />□ System Development Charge <br />La-CaSSeInspected By <br />ctwKCtftw to pubOc mwm- h conformnanc* to Ctty ttandardm and tpacHkadont. <br />Public Wastewater Information <br />34 Inspected By — <br />330Q5TSegment No. ^££1Index Page No.Contract No.Downstream <br />TWO WORKING DAYS BEFORE YOU DIG, CAi_L UT1UTY ONE-CALL SERVICE AT 1-800-332-2544 <br />in’>O <br />35' <br />\0y <br />% <br />Vg U’ <br />/ <br />&i <br />f