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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: <br />Name (print): <br />Address: Email: <br />City/State/Zip: <br />Signature: <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <br />Phone: Fax: <br />Date: <br />Address: Email: <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 />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: May 25, 2018 <br />Planning & Development Updated: December 2016 <br />Planning Division <br />99 W. 10" Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or F-mail:eugeneplanning(o)ci.eugene.or.us Page 3 of 4September 10, 2018, Meeting - Item 2D