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ADDITIONAL INFORMATION <br />, Adj oining Property.Owners and Their Address and Phone Numbers (if more than S, attach printed labels *) <br />See attached mailing information and labels <br />Has the proposed activity or any related acrivity received the attention of the Corps of Engineers or the Department of State ` <br />Lands in the past, e.g., wetland delineation, violation, permit, lease request, etc:? ~Yes ~No <br />If yes, what identification number(s) were assigned by the respective agencies: <br />Corps # State of Oregon # <br />Has a wetland delineation been completed for this site? ~Yes ~No <br />If yes, by whom *Satre Associates Sept 1996 (outdated) <br />Has the wetland delineation been approved by DSL or the COE? DYes ONo <br />I es, attach concurrence letter. * <br />:'n CITY/COiJNTYPLANNING DEPARTM.~NTAFFIDAVIT to be com leted b local lannin o acial * <br />I have reviewed the project outlined in this application and have determined that: <br />QThis project is not regulated by the comprehensive plan and land use regulations. <br />^This project is consistent with the comprehensive plan and land use regulations. ~.G 16.7lL~,a~~6~ <br />~,This praject will be consistent with the comprehensive plan and land use regulations when the following local <br />approval(s) are obtained. <br />^Conditional Use Approval [~Development Pernut ~,Other ~ip~~'~~ ~,M~i~~~ ~ ~~,~ <br />l t! <br />^This project is not consistent with the comprehensive plan. Consistency requires a <br />pPlan Amendment ^Zone Change ^Other <br />An ap lication has ~has not been filed for local approval checked above. , <br />~t~l.~-~ ~~~~U~-~~ ~(~r ~. ~113~~n <br />Local planning official name (print) Signature Title C-~ / County Date <br />Comments: W~"I.a~ G~' -~O~J ~.~a1~0/~~ i.~v ~~N68n~'" <br />8 COASTAL Z4NE CERTIFICATION * <br />If the proposed activity described in your pernut application is within the Ore~;on coastal zone, the following certification is required before <br />your application can be processed. A public notice will be issued with the certification statement, wluch will be forwarded to the Oregon <br />Department of Land Conservation and Development for its concurrence or objection. Eor additional infomiation on the Oregon Coastal <br />Zone Management Program, contact the departrnent at 635 Capitol Street NE, Suite 150, Salem, Oregon 97301 or ca11503-373-0050. <br />CERTIFICATION STATEMENT <br />I certify that, to the best of my lrnowledge and belief, the proposed activity described in this application complies with the approved Oregon <br />Coastal Zone Management Program and will be completed in a manner consistent with the program. <br />Print lType Name Title <br />A licant Si ature Date <br />~ <br />' Page 7 <br />