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REPRESENTATIVE (If different from Surveyor): <br />Name (print): (DF y 6 5t&1 (/t ~10USE <br />Corn nanv/Organization: <br />Address: j(0 i(o 5,,St"i.r s V I'st,) <br />City/State/Zip: ~~Phone: l~~~F'ax: <br />E-mail: qjg lo LA T, vH~l I• CvvL-"- <br />Signature: Date: <br />Attached additional sheets if necessary. <br />Planning & Development Updated: December 2016 <br />Planning Division <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 />Attachment C <br />November 25, 2019, Meeting – Item 2C