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hbWf • <br />tft <br />r <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: g] SFD <br />UmQuA A\)^ <br />Owner <br />□ Duplex □ Multi-Family □ Commercial □ Industrial <br />Permit Information <br />Permit No. <br />rnntrnntnr/PInmhffr _____ <br />□ Right of Way Cut Permit Required <br />Installation Date <br />PwnMon aranM to oltocfi ivAoto <br />of Issue CH I \ Q / <br />SQU+O <br />Date <br />Pipe Material <br />□ System Development Charge <br />Inspected By '-A. ov^6'l /1 Uj. <br />connection io pubOc mwtr h confotmnanc* to Qty ttondarth and ycflfertfam <br />4"Pipe Diameter. <br />WlYl W <br />Public Wastewater Information <br />Index Page No—LLt.21Mlnsp^By <br />DownstreamSegment No Contract No.Upstream <br />TWO WORKING DAYS BEFORE YOU DiG, CALL UTILITY ONE-CALL SERVICE AT 1-800-332-2344 <br />2l\W 2W <br />O Oi <br />So1 <br />coo— <br />io' <br />8 2 Cl" <br />rr^ <br />. <br />^ - ■ <br />! <br />)