HomeMy WebLinkAboutBuilding Miscellaneous 1976-4-28
, ,kine county
AC-rJITY INFORMATlO~HEET ~
COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! 3?~2.. 0a..~
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~ll~g~G (~QUU~ PROPERTY OWNER
~-
MAILING ADDRES \.../ MAILING ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
BUSINESS TELEPHONE #
HOME TELEPHONE #
BUSINESS TELEPHONE #
HOME TELEPHONE # '
2 PROPERTY ADDRESS
(IF DIFFERENT FROM MAILING ADDRESS)
TOWNSHIP
(from tax maps in Department of Assessment and Taxation
-3 from ~state:en:) 70-0/ d- 7 0/ /'
RANGE ~ TAX LOTtS' OR PARCEL ',jP~1tG I
RAN" SECTION TAX LOllS) OR PARCEL , ~I~ jlA
TAX LOT(S) OR PARCEL # ~G
3 MAP & PARCEL NUMBER
(REQUIRED INFORMATION)
TO(NS]P
TOWNSHIP RANGE SECTION
TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP:
4 SUBDIVISION (if applicable)
5 REQUEST (state exactly what you plan to do)
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o
-,LOT
(
ACRES
BLOCK
-
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6 DIRECTIONS TO SITE:
** FOR STAFF USE .ONLY **
NUMBER
DATE
....
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....
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ZONE/LAND USE:
BY: DATE:
TIME IN:
OUT:
LAND MANAGEMENT DIVISION / 125 E. 8th AVE.. EUGENE. OR 97401 / 687-4061