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Permit Building 1986-10-17
ACr:r-~VITY TNFORMATIOl' '~SHEET . ~ . , , '" . , ...... ,..,.~. - I I.I,~ COMPLETE THIS SECTION: INCOMPLETEF~RMS WILL BE REJECTEP! =--YIJ~I~\i~ :.---.. ____n ... ~ P~~N 'Mft:ktNG 'REQUEST , \/~ S I' h\J\JQ~ \.~V', " , MA I LING ADDRE"SS '3(\L \J " ~)~)) \ ctry- " STATE ZIP CODE 14. ~ \:j\Jq~ BUSINESS TELEPHONE j HOME TELEPHONE # ' j 2 PROPERTY ADDRESS ' ~ \ ~ (IF DIFFERENT FROM MAILING-ADDRESS) '0"~\ , ' ~ "..... PROlERTY OWNER "I, MAILING ADDRESS CITY C;i (0 Z- G?\p BUSINESS TELEPHONE # STATE ZIP CODE HOME TELEPHpNE # : 3 MAP & PARCEL NUMBER, (REQUIRED INFORMATION) (from tax maps in Department of Assessment and Taxation: or from tax statement) \r \)~ 554/1 .' f)Lf\ \()\ .A6J TOWNSHIP RANGE SECTION TAX Lt1T(S-)OR PARCEL # ZONING ~ TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING TOWNSHIP R~NGE SECTION TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: ; 4 SUBD1VISION (if applicable) . 5 REQUEST (state exactly what you plan to do) , , j 6 DI RECTIONS TO SITE: ~ , . ) l TAX LOT(S) OR PARCEL # ZONING. ACRES LOT BLOCK I ~~~ I I,. ' / (/ AI .II , ~/q- O~..-:. ~ .. /b~_ )fi:/ ./- r"'--v- ~~ j . j ; oj,.................", ",.. ,..,..,..,u.., ,,_.., ..- ,. ". ,"... ....,.. ,.,_..- .... ,. -.. ,** FOR STAFF USE ONLY** .. ., .. - ... ,f/ ZONE/LAND USE: ~ \ t OA..c. '.~JL~' ~' ~o1J!'V\4 (e; -17-8:6 _~'l~ \~O~ Jb~ ,cJf)~r1) ,~,' , CCfV[. G ~ 14,-33, ~) LAND MANAGEMENT DIVISION / 125 E. 8th AVE., EUGENE, OR 97401 / 687-4061