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r bbW'l <br />SCANfJmi.Public Works <br />MaintenanceLocation of <br />Wastewater Connection 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />Property Information <br />Address . '_:_Lj__:----- <br />Map and Tax Lot------ <br />Building Type: g] SFD <br />y <br />__________^ __7__.Owner <br />□ Duplex □ Multi-^Family □Commercial □ Industrial <br />Permit Information <br />Permit No. <br />Contractor/Plumber <br />□ Right of Way. Cut Permit Required <br />Installation Date <br />Psrmfnhn aranM to attach prtvot* <br />'Ct-OWlS-Ol Date of Issue («? <br />Pipe Material ____ <br />□ System Development Charge, . <br />Inspected By __Cl *»-f <?[ *^.1 <br />Pipe Diameter. <br />IQ/CM /l^ <br />h conformnaoc* to Oty standard* and sotchkahans.ccnhoctfoa to ptMfc <br />Public Wastewater Information <br />Segment No.23^nspect|fuB/ <br />DownstreorrT <br />\l 2»Index Page No..-Contract No.Upstream <br />TWO WORKING DAYS BEFORE YOU DIG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />^CJb <br />I^ ' (>nnec/W, <br />-A-C W'^S UAcLt/ <br />\?-oi-nx-o\ <br />! <br />! <br />N=> <br />O <br />nVo