<br /> <br />Planning&DevelopmentUpdated:March2014 <br />PlanningDivision <br />99W.10THAvenue,Eugene,OR97401 <br />Phone:541.682.5377orEͲmail:eugeneplanning@ci.eugene.or.usPage3of4 <br /> <br />Bysigning,theundersignedcertifiesthathe/shehasreadandunderstoodthesubmittalrequirementsoutlined,andthathe/she <br />understandsthatomissionofanylisteditemmaycausedelayinprocessingtheapplication.I(We),theundersigned, <br />acknowledgethattheinformationsuppliedinthisapplicationiscompleteandaccuratetothebestofmy(our)knowledge. <br /> <br />PROPERTYOWNEROFTAXLOT:      <br /> <br />Name(print):             <br /> <br />Address:         Email:      <br /> <br />City/State/Zip:         Phone:      Fax:      <br /> <br />Signature:Date:      <br /> <br /> <br />PROPERTYOWNEROFTAXLOT:     <br /> <br />Name(print):             <br /> <br />Address:         Email:      <br /> <br />City/State/Zip:         Phone:      Fax:      <br /> <br />Signature:      Date:     <br /> <br /> <br />PROPERTYOWNEROFTAXLOT:     <br /> <br />Name(print):             <br /> <br />Address:         Email:      <br /> <br />City/State/Zip:         Phone:      Fax:      <br /> <br />Signature:      Date:     <br /> <br />SURVEYOR: <br /> <br />Name(print):       <br /> <br />Company/Organization:      <br /> <br />Address:      <br /> <br />City/State/Zip:         Phone:      Fax:      <br /> <br />EͲmail:          <br /> <br />Signature:Date:      <br /> <br />Kent Baker <br />Roberts Survey <br />541-345-1112 <br />2811 Lydick Way <br />Springfield, OR 97401 <br />1300 <br />Jeff Tunnell <br />82467 Howe Ln <br />Creswell, OR 97426 <br />jeff.tunnell@gmail.com <br />01-02-26