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<br /> Enter Document Title <br /> <br /> <br /> www.eugene-or.gov/planning <br />Planning & Development Updated: December 2016 <br />Planning Division Updated: September, 2012 <br />99 W. 10TH Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 4 of 4 <br /> <br /> <br />REPRESENTATIVE (If different from Surveyor): <br /> <br />Name (print): <br /> <br />Company/Organization: <br /> <br />Address: <br /> <br />City/State/Zip: Phone: Fax: <br /> <br />E-mail: <br /> <br />Signature: Date: <br /> <br />**Attached additional sheets if necessary. <br />