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1 <br /> Planning & Development <br /> Permit and Information ~~~enter <br /> R@C@ipt 99 West 10th Avenue <br /> ' Eugene, Oregon 97401 <br /> (541)682-5086 <br /> - ~2us s ~1-o Y ~ <br /> M hod of Payment: Received From ~ D ~ i?`Lly i~ <br /> Cash ~IVl~ l ~l ~l2-l <br /> Check Address Stc'~ p~ R..~ <br /> Visa/MC <br /> Phone ( ) ~t,ISS ~ `f E?~--~ 5 ~O <br /> Amount Received <br /> ~ 5--~ Description/Reference Numb r: ~ <br /> L~412~ nJ u rf ar= E7.14&~!~ <br /> J ~ 0 D $ Z'~ Application Name - <br /> Application Type ~R-oi? L1 NE ~ DJ Application # <br /> LAND PLAT <br /> 1~I~'` 5110 Land Use Application ? 6130 Plat <br /> (Final Plat) <br /> <br /> - Post-Monumentation Pa ments must be made at 858 Pearl Street. ~ <br /> Date ~ 20 3 OFFICE USE <br /> Staff Initials s <br /> ~~E1VF <br /> D <br /> oc~ a~ <br /> i s~ <br /> <br />