bbH5^'t .v <br />Public Works <br />MaintenanceLocation of <br />Wastewater ConnectionSCANNE 1820 Roosevelt Blvd. <br />Eugend, Oregon 97402 <br />(541) 682-4800 <br />•< <br />Property Information <br />Address . '_:______ <br />Map and Tax Lot — <br />Building Type: @ SFD □ Duplex □ Multi-Family □Commercial □ Industrial <br />(MPQUA <br />Owner <br />Permit Information <br />Permit No.Date of Issue O ; ’/ ^/ '■ ’"l <br />nr.nfmrtor/Pliimhfir TT. pjpe Material.' ' ^ 1, 0— Pipe Diameter. <br />□ System Development Charge <br />Inspected By t—VqMO <br />□ Right of Way Cut Permit Required <br />Installation Date ^ ^ j y /' \ —-------- <br />comcHoa to puMcPermMai oranM to attach prtmta <br />^nolnsp«£Public Wastewater Information . <br />Index Page No.-Segment No.Contract No.DownstreamUpstreom <br />TWO WORKING DAYS BEFORE YOU DIG, CALI. UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />NlY <br />I-S1 <br />u'-s" V <br />K <br />/t'-r <br />; <br />i <br />/ <br />n' '"O <br />3t'\l\'wno o oUIWPQ,UA A\l€a.'iiu?,