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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 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: 1401 <br />Name (print): The Estate of Nancy Ann Chase, deceased - By: David Hollomon, Executor <br />Address: 826 NE Hidden Valley Drive, Unit 2 Email: davefor.ncestate@yahoo.com <br />City/State/Zip: Bend, Oregon 97701 Phone: 541-549-1544 Fax: <br />Signature: Date: See attached <br />PROPERTY OWNER OF TAX LOT: 1402 <br />Name (print): Michael LeCompte <br />Address: 2 Chevy Chase Lane Email: michael.lecompte@festo.com <br />city/state/zip: Eugene, OR 97401 Phone:541-221-7237Fax: <br />Signature: Date: See attached <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <br />Address: Email: <br />City/State/Zip: Phone: Fax: <br />Signature: Date: <br />SURVEYOR: <br />Name (print): Kent Baker <br />Company/Organization: Roberts Surveying, Inc. <br />Address: P.O Box 7155 <br />City/State/zip: Springfield, OR 97475 Phone:541-345-1112 Fax: <br />E-mail: kent@robertssurvey.com <br />Signature: Date: See attached. <br />Planning & Development Updated: December 2016 <br />Planning Division <br />99 W. JOT" Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 4September 10, 2018, Meeting - Item 2D