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<br /> ' <br /> Section 6: A lication Verification <br /> I certify that I am familiar with the information contained in the application, and that to the best of my knowledge and belief, <br /> such information is true, complete, and accurate. •I understand that if credits are available from the Bank to service this <br /> request, the Bank will reserve those credits for up to 45 calendar days from the date I am notified of their availability. I <br /> understand that if I do not purchase the credits within that 45-day period, the credits will no longer be reserved forme. <br /> Z -2 l - o ~ <br /> <br /> ' Signature of Applicant or Authorized Agent Date <br /> Si nature of A licant or Authorized A ent Date <br /> ~ ~ ;FOR OF)E~1'C`E USE OILY. ` ' i y . <br /> i <br /> it. _ ' <br /> ~Dat~~pQlicatton receiYed (rio~opt6/dav/yFar) ~ ' <br /> ~ls thi's project located: wttllip the West~ugena Wetlands P-tan Boundary' ~ <br /> a ~ ~ t <br /> q Within the Eugene:Urban Grovrtl? ~ouadary (UGB) <br /> ~ t <br /> d ~ ,D Wltllln ~1e;,EUger1C,A1rpOrt'bOUndaT}' s <br /> ~s,~a ~ ti ~ r <br /> ~ , ' ` t~~outstde 'the Eugene USiB Airport boupdary,-and Weilands Plan Boundary <br /> li Wetland type(s) affecfed* wet pratr~e _ shrub/sertib, emergent; forest agricultural crop land, pasture, Old <br /> ` } r field fill ~ ~ , <br /> <br /> i ~ S i ~ <br /> ~~3abttat quality* t Thigh fair low _ ~ <br /> Y r` <br /> 1 ti ~a 1,~ ~ ~ <br /> <br /> i ~ s ,~l . , <br /> <br /> ~ i ~ hon bank saleraho 75 ' 1 50 _ 1.25 -<l 0 <br /> ~~Credits needed i ~ " ;x + <br /> ~ ;Sale raho impact°acie§ °`eredits needed 'fit <br /> ~ <br /> I <br /> _ , <br /> <br /> ~ ~rec~ts availab4e to service request: ~ yes no + ~ s <br /> i <br /> ~Date,Applicant or Authorized Agent ?otified'o[ credit status (month/da~'/year) 7 ~ / ^i~ <br /> i ~ <br /> . ^ ~i <br /> P" <br /> 3 17,~m~~he W'eg~~`~u en~i~aettAgd .~lEtt#, ~pcludin 't'able 1 ' ,a " ~~.'~'r'~~.' <br /> z~~ <br /> Submit the cpmpleted form to: Dal Ollek <br /> ATTN: Mitigation Bank Application <br /> City of Eugene <br /> 1820 Roosevelt Blvd ' <br /> Eugene, OR 97402 <br /> <br /> ' ' [Credit-Request-Form-Jan04] <br /> • Page 2 of 2 <br /> <br />