HomeMy WebLinkAboutPermit Miscellaneous 1986-5-27 (3)
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ACT_TV. INFORMATIO~HEET
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PROPERTY OWNER -~ i
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MAILING ADDRESS i
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HOME TELEPHONE # I
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GOMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED!
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PERSON MAKING REQUES" ---
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MAILING ADDRESS
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\ITY STATE ZIP CODE
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BUSINESS TELEPHONE'# HOME TELEPHONE # BUSINESS TELEPHONE #
2 PROPERTY ADDRESS ~_ ~~"'-.Q ,>
(IF DIFFERENT FROM MAILINu AUUKt~~)
3 MAP & PARCEL NUMBER
(REQUIRED INFORI1ATION)
(from tax maps in Department of Assessment and Taxation
or from tax statement)
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SECTION TAX LOT(S) OR PARCEL # ZONING
TOWNSH I p' RANGE' SECT! ON TAX LOT(S) OR PARCEL # ZONING
TOWNSH I P RANGE' SECTION TAX LOT(S) OR PARCEL # ZONING
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ACRES
4 SUBDIVISION (if applicable) LOT BLOCK
5 REQUEST (state exactly what you plan to do)
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6 DIRECTIONS TO SITE:
** FOR STAFF USE ONLY **
NUMBER
DATE
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ZONE/LAND USE:
BY: DATE:
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TH1E IN:
OUT:
LANO MANAGEMENT DIVISION / 125 E, 8th AVE., EUGENE, OR 97401 / 687-4061