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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: 5200 <br />Name (print): Day Joint Trust. Representative: Frank Day <br />Address: 795 Park Ave Email: gfday@comcast.net <br />City/State/Zip: Eugene, OR 97404 Phone: 541-689-5035 Fax: <br />Signature: L'Y" Date: <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <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): Daniel Nelson, PLS <br />Company/Organization: Branch Engineering, Inc. <br />Address: 310 Fifth Street <br />City/State/Zip: Springfield, OR 97477 Phone:541-746-0637 Fax: <br />E-mail: DanN@branchengineering.com <br />Signatur Date: <br />Planning & Development <br />Planning Division <br />99 W. 10- Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us <br />Updated: December 2016 <br />Page 3 of 4November 13, 2018, Meeting - Item 3D