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Attachment C <br />BY signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/ <br />understands that omission of any listed item may cause delay In processing the application. I (We), the undersigned! <br />acknowledge that the information supplied in this application Is complete and accurate to the best of my (our) knowledge. <br />PROPERTY OWNER OF TAX LOT., C <br />Name (print): <br />7 <br />Address: Email: <br />City /Sta!e/Zip. <br />Phone � <'-1 Lj� �L F <br />Signature :)',""'-','� Date: <br />, 1, , """e— — 7�' I ti 711 <br />PROPERTY OWNER OF TAX LOT: G'('00 <br />Name (print): "A � <br />"k <br />cwl r & 4 <br />Address 2"77 <br />Emall:.... <br />City/State/Zlip, <br />nature <br />Name (print): <br />Phone <br />Address: Email: <br />City/State/Zip: Phone: <br />Signature: Date. <br />SURVEYOR: <br />Name (print): <br />...� LL <br />Company/Organization. ...........ti <br />Address: <br />4., VZ'!",4 <br />M <br />M <br />Cit�y/State/Zip: CL 'L <br />Phone-, Wto 1!& " Fax: <br />Planning & Dewelopment <br />Planning Division Updated, March 20IL4 <br />99 W 10'" Avenue, Eugene, OR 97401 <br />Phone: 541.682,5377 or E-mail:eugeneplanning@cu'.eugene.or.us Page 3 of 4 <br />