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MARION COUNTY PUBLIC WORKS <br /> 414:-• BUILDING INSPECTION DIVISION <br /> 0N <br /> DJ1! .E2N(2):p2V0:cr Eli y: <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 - LI <br /> (503)588-5147 Fax (503)588-7948 <br /> l <br /> . : http://www.co.marion.or.us/PW/Buildinglaspection BILIADRIN1°Gi <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 1, IAN ING _,have authorized <br /> (Property Owner/Print Name) <br /> NORWOOD EXCAVATION LLC RICK NORWOOD to act as my agent in performing the <br /> (Authorized Representative/Print Name) <br /> activities necessary to obtain site evaluations,permits,and other onsite wastewater treatment program <br /> services provided by the Department of Environmental Quality or County Agent on the property <br /> described below in accordance with OAR chapter 340,division 071. <br /> PROPERTY IDENTIFICATION: <br /> 7786 DOVICH LANE SE <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 082W30DB00300 Tax Lot#(s)0300 <br /> PROPERTY OWNER: <br /> Lii <br /> • <br /> Printed Name: v.-)- <br /> Signature: 40,1. <br /> 11116sh aor <br /> Date: <br /> Address: PO e'o.) ;2F b Phone 1 7/ 61 of 3 SC:91 <br /> city, State,Zip 5aI ' q.7,308 Fax: <br /> E-mail Address lao • itijs@ ou1-100k , Cow) <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: RICHARD NORWOOD <br /> Company Name: NORWOOD EXCAVATION LLC <br /> signature:RICHARD NORWOOD E-SIGNED Date: 12.17.2020 <br /> Address: 14140 S SPANGLER ROAD phone:971.241A841 <br /> city,state,zipOREGON CITY OR, 97045 Fax:NM <br /> (E-mail Address NORWOODEXCAVATIONLLC@GMAILCOM <br /> DEQ License# 39188 CCB it 225183 <br /> G:TORNISISEPTICi.5-07 Awl'to Apply(lac <br /> MCS-07 Rev 03110 <br /> SEP tie 4 <br />