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r , <br /> City /County Planning Department Affidavit <br /> (to be completed by local planning official) <br /> O This project is not regulated by the local comprehensive plan and zoning ordinance. ,P~ "~5, <br /> This project has been reviewed and is consistent with the local comprehensive plan and zoning ordinance. <br /> O This project has been reviewed and is not consistent with the local comprehensive plan and zoning ordinance. <br /> 0 Consistency of this project with the local planning ordinance cannot be determined until the following local approval(s) are <br /> obtained; <br /> O Conditional Use Approval O Development Permit <br /> O Plan Amendment O Zone Change <br /> O Other <br /> An applicati O has O has not been made for local approvals checked above. <br /> ~4-sBDc.~~7'~ ~~ti~ 1~-~-- tf~ 2S = O j <br /> 'gnature (of 1 craning o8'icial) Tifle City /County Date <br /> Coastal Zone Certification <br /> If the proposed activity described is your permit application is within the Oregon coastal zone, the following certification is required before <br /> your application can be processed. A pablic notice will be issued with the certification statement which will be forwarded to the Oregon <br /> Department of Land Conservation and Development (DECD) for its concurrence or objection. For additional information on the Oregon Coastal <br /> Zpne Management Program, content the department at 1175 Court Street NE, Salem, Oregon, 97310, or call 503-373-0050. <br /> Certification Statement <br /> I certify that, to the best of my knowledge and belief, the proposed activity described in this application complies with the approved Oregon <br /> Cpastal Zone Management Program and will be completed in a manner consistent with the program. <br /> n/a <br /> Print /Type Name Title <br /> n/a <br /> Applicant Signature Date <br /> 9.', Signature for Joint Application <br /> Application is hereby made for the activities described herein. I certify that I am familiar with the information contained in the <br /> application, and, to the best of my knowledge and believe, this information is true, complete, and accurate. I further certify that I possess the <br /> au~hority including the necessary requisite properly interests to undertake the proposed activities. I understand that the granting of other permits <br /> 'bylocal, county, state or federal agencies does not release me from the requirement of obtaining the permits requested before commencing the <br /> ',project. I understand that local permits may be required before the state removal -fill permit is issued. I understand that payment of the <br /> ;required state processing fee does not guarantee permit issuance. The fee for the state application must accompany the application for <br /> r~o~npleteness. Amount enclosed S <br /> Teri Higgins ProjectManager. Eugene AirportProjects <br /> Pript /Type Name Title <br /> Applicant Signer Date <br /> I certify that I may act as the duly authorized agent of the applicant. <br /> rc el W. Shi ~ .Principal /Coyote CreekEm~ironmental Services <br /> <br /> Ihint /Type ame ~ ~ Title p_ ~ ~O <br /> U,.t,e(/? ~ ~ , ~ <br /> <br /> Authorized Agent Signs e Date <br /> Coyote Creek Errvironmenta! Services o,~ice: (541) 484-7336 <br /> <br />