Acknawledsment <br />I (we), the undersigned, hereby acknowledge that I (we) have read the above appeal form, understand the requirements for filing an <br />appeal of a planning director decision, and state that the information supplied is as complete and detailed as is currently possible, to <br />the best of my (our) knowledge. <br />APPELLANT: <br />5 <br />Company/Organization; %1AL1';-7`; L~ f t Zt t j <br />Address: -0QlkJE <br />l7-4jC11WE . cxz T74-0 3 <br />APPELLANT'S REPRESENTATIVE: <br />Name (print): <br />Address: <br />City/State/Zip- E-mail (if applicable): <br />Phone: Fax. <br />Signature: <br />IF this appeal is being filed by the affected recognized neighborhood association, complete the following: <br />Name of Association: <br />l_1tL-lk- ',.j A-LZY C~t';ti7.jgt.Lg <br />www. a ugene -or. go v/pl an n i ng <br />Planning A Development <br />Planning Division <br />99 W. 10M Avenue, Eugene, DR 97401 <br />P 541.682.5371 ' F 541.685.5572 <br />Updated: October, 2012 <br />Page 2 of 2 <br />Laurel Ridge Record (Z 15-5) Page 18 <br />