HomeMy WebLinkAboutPermit Miscellaneous 1990-1-1
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ACTIVITY INFORMATION SHEET
Idne county
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COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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PERSON MAKING REQUEST
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MAILING AOORESS
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PROPERTY OWNER .
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MAiLiNG ADDRESS ~
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CITY
STATE
ZIP CODE
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7 (1(,.-,;1/ -IS"
BUSINESS TELEPHONE /I
/1y v 7,/77
STATE ZIP COOE
711(.-777'7
HOME TELEPHONE /I
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BUSINESS TELEPHONE./I
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HOME TELEPHONE /I
,2 PROPERTY ADDRESS "vlll
(IF DIFFERENT FROM MAILING ADDRESS)
3 MAP & PARCEL NUMBER
(REQUIREO INFORMATION)
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TOWNSHIP
(from tax maps in Department of Assessment and Taxation ~
or from tax statement)
~ si?rdN' ~-TAtLOT(S)?:Zr::P ZONING
TOWNSiffp RANGE' SECTION TAX LOT{S) OR PARCH /I ZONING
TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL /I ZONING
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TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ACRES
4 SUBDIVISION (if applicable) Je.y"./ ..2)ut, LOT BLOCK
5 REQUEST (state exactly what you plan to do) ,4 nn ,-"., ;:" /)/Ir
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6 DIRECTIONS TO SITE: .AL.l1.1L___el:t{(.(Jf.m..d.~~h m .6.r~. .$c/Ju--',
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** FOR STAFF USE ONLY **
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NUMBER
OATE
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ZONE/LAND USE:
BY: OATE: TIME IN:~---OUJ:
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LAND MANAGEMENT DIVISION / 125 E. 8th AVE.. EUGENE. OR 97401 / 687-4061