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HomeMy WebLinkAboutPermit Building 1994-10-16 7f:(... ' . ", . ACT}~\~i;TY INFORMATION .JHEET 'ldne ,county COMPLETE THIS SECTION. INCOMPLETE FORMS WILL BE REJECTED! --- [l-UU ..... U l ~ ~ , 3 ; .- ! r V tl-e/A -e _ '-./ C!TY ?/" I k e. Ij 'r-' a "'(-BA-- . PERsoN MA~G REQUEST /c:J{;;5 h~h.Jr ~r~ 4, MAILING ADDRESS. a~ STATE ZIJ ~,~ f- 0u wtPIJ . PROPERTY OWNER 3 .Ly' ~ 7 f3c;,/c4 (~Iew MAILING A'B'DRESS /'1--, . ! ! 97/1c:/ Z ZIP CODE ~r/Jc/ , t !TY Or"f STATE r7'-177 ZIP CODE 4tLf- JJts BUSINESS TELEPHONE # HOME TELEPHONE # 7Lf7- & 70l( BUSINESS TELEPHONE # HOME TELEPHONE # : 2 PROPERTY ADDRESS (IF DIFFERENT FROM MAILING ADDRESS) i 3 MAP & PARCEL NUMBER , (REQUIRED INFORMATION) 1 ToLL (from tax maps in Department of Assessment and Taxation: . ~ from lCftatement)/ 0 -;; ! RANGE SECTION TAX LO~ OR PARCEL # ZONING TOWNSHIP RANGE SECTION TAX LOT(S) OR PARCEL # ZONING TOWNSHIP RANGE SECTION TOTAL CONTIGUOUS PROPERTY IN SAME OWNERSHIP: TAX LOT(S) OR PARCEL # ZONING ACRES ,4 SUBDIVISION (if applicable) LOT BLOCK i 5 REQUEST (state exactly what you plan to do) #dc::1rt""S':5 f!~ <~ hCJp b U/ /~/hJ~ OVI-t-t-; -e bcJ ( k f -I--? '"f' ?r?l,LJ--L4 ~)v /" ~~ C r- 0 //1/1 ,II/) L'/I,;- //1 /1 1/1,... ...p bC C l...J /.") 6?' #C7"""VI f 1v /V/'//'V/4 Sllv?<7 / I " '-' '-J l6 DIP-tenONS TO SIT[': ~~-iii!? C V////f/et 5 ~ ~ ,-~t""C & fJ~ wS'/c S . ~. v 'V. 1 l .J. . ... .. .....,.. .... ".ri NUMBER . ~ ~ DATE /1&ltp ** FOR STAFF USE ONLY ** ZONE/LAND USE: BY: r}j_:~:IN~~ le- ek ~ 0 C~ o-:f.aM<!, /'\ . . l~~ ~ LAND MANAGEMENT DIVISION / 125 E. 8th AVE.. EUGENE. OR 97401 / 687-4061