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By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she <br />understands that omission of any listed item may cause delay in processing the application. I (We), the M"knwjlt C <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: 3701 <br />Name (print): Robert W. Tate & Sharon L. Tate <br />Address: P.O. Bo26423 Email. bobt@dynastyconcrete,coo <br />City/State/zip: �uene, OR 97402 Phone. 541-914-9918 Fax: <br />Signature: <br />PROPERTY OWNER OF TAX LOT; <br />Name (print): <br />Address: ErnaH: <br />City/State/Zip: Phone: Fax: <br />Signature: Date: <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <br />Address- Email.- <br />City/State/Zip: Phone: Fax: <br />Signature: Date: <br />SURVEYOR: <br />Narne (print): Michael R. Dahrens, O'regon LS 60052 <br />Company/Organization: SSW Engineers Uric. <br />Address: 2350 Oakmont Way, Suite 105 <br />City/State/Zip: Eugene, OR 97401 Phone: 541-485-8383 Fax: 541-485-8384 <br />E-mail: miked@sswengineers.com <br />Signature. Date: 0? <br />ing & Development Updated. March 2014 <br />Planning Division <br />99 W, IOTA Avenue, Eugene, OR 97401 <br />P,hone� 541.682-5377 or E-mail:eugeneplanning@ci,eugene.or.us Page 3 of 4 <br />