Agenda Packet 10-8-18 Meeting - Laserfiche WebLink

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By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she understands that omission of any listed item may cause delay in processing the application. I (We), the undersigned, acknowledge that the information supplied in this application is complete and accurate to the best of my (our) knowledge. PROPERTY OWNER OF TAX LOT: Name (print): Address: Email: City/State/Zip: Phone: Fax: Signature: Date: PROPERTY OWNER OF TAX LOT: Name (print): Address:Email: City/State/Zip:Phone: Fax: Signature:Date: PROPERTY OWNER OF TAX LOT: Name (print): Address:Email: City/State/Zip:Phone: Fax: Signature:Date: SURVEYOR: Name (print): Kent Baker Company/Organization: Roberts Surveying, Inc. Address: P.O. Box 7155 City/State/Zip: Springfield, OR 97475 Phone: 541-345-1112 Fax: E-mail: kent@robertssurvey.com Signature:Date: May 25, 2018 Planning & Development Updated: December 2016 Planning Division 99 411..10"I Avenue, Eugene. OR 97401 Phone: 541.682.537 7 or E maiLeui eneplanning(e)c.e!arene.onus Page 3 of 4 October 8, 2018, Meeting – Item 3C