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~R JQINT ~pLI~ATIt3N i~ <br /> SI~1~TA~1`~E F <br /> ' I am familiar with the information co I~as es <br /> <br /> (9} er cerhfy that p . <br /> is hereby made far the acti~?ities described herein. I cenc~amplete, and accurate. I h federal agenc~e: <br /> Application local, county, state or <br /> e best of my knowledge and belief, this informati~tin of other permits by that ~ went of the <br /> and, to th . <br /> ertake the proposed activities. I understand thu ~ <br /> ~ <br /> before commencing the proaect. I understd P J' <br /> and the ermits req aecan~dny tie ~p~~icdiian,far' <br /> from the requirement of obtaining Tg~~ issuQne~• ~'~~.~'~~°r t~~ st'~t~ `~~~~i~an ~ <br /> processing f~~ does not gudrernnte p~ <br /> ~a~nt enclosed ~~~D. <br /> Title <br /> Print 1Tyge dame <br /> Date <br /> { <br /> applicant Signature ent of tb.e applicant. <br /> I certify that I may act ~ the duly authorized ag <br /> Title <br /> Print lT~pe Name <br /> John Bonham <br /> Project Manager <br /> Public Works Engineering <br /> City of Eugene <br /> Office 541-682-5300 <br /> Fax 541-682-8410 <br /> 3 <br /> <br />