Note: This is not a complete list of requirements. Additional information may be required after further <br />review in order to adequately address the applicable approval criteria. <br />By signing, the undersigned certifies that he/she has read and understood the submittal requirements <br />outlined, and that he/she understands that omission of any listed item may cause delay in processing the <br />application. I (We), the undersigned, acknowledge that the information supplied in this application is <br />complete and accurate to the best of my (our) knowledge. <br />OREGON LICENSED SURVEYOR* (As required under EC M410(1)) <br />*If surveyor has signed the site plan(s), signature below is not required. <br />Name (print): Donald Nickell <br />Company/Organization: <br />Nickell Land Surveying PLS #: 2585 <br />Phone: 541-968-2905 <br />Signature: <br />E-mail: nickell2u@msn.com <br />www.eugene-or. pov/planninq <br />Planning & Development Updated: January 2026 <br />Planning Division <br />99 W. 10 "Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail: plannin eu ene-or. ov <br />Page S of 5 <br />