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DocuSign Envelope ID:DC5C2882-79B6-4EAF-9D4C-2EA9894F01A9 <br /> ETY <br /> ub bn <br /> MARION COUNTY PUBLIC WORKS � + " <br /> BUILDING INSPECTION DIVISION ImEAORCCI0TN' <br /> E0 Vj`i. g 5155 Silverton Rd NE 16Salem OR 97305 z�1 3 <br /> (503)588-5147 Fax(503) 588-7948 <br /> http://www.co.marion.or.us/PW/Buildinglnspection BMD� G INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> Justi n Cherrington <br /> ,have authorized <br /> (Property Owner/Print Name) <br /> Flow Line Construction LLC 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 /> 107 E St, Gates, OR 97346 <br /> H1v re,b Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description SEC 26 TWN 095 RNG 03E Tax Lot#(s) Parcel #0 093E26CCO2800 <br /> PROPERTY OWNER: <br /> Justin <br /> Printed Nanm.e:.DocuSigned by <br /> Signature: Date: October 11, 2023 112:13 PM PDT <br /> '-28C6DFBA77F043F... (503) 510-8341 <br /> Address: 1206 Lotti a Ln NW Phone: <br /> City, State,Zip salem, OR Fax: <br /> E-mail Address just;ncherrington@protonmai1.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Trey Renoud <br /> Company Name: Flow Line Construction LLC <br /> Signature:—<;;; C1� Date: 1 0/11/23 <br /> Address: 11805 State St Phone:503-871-2260 <br /> City, State,ZipSalem, Or, 97317 Fax: <br /> E-mail Address Construction.flowline@gmail.com <br /> DEQ License# 39474 CCB# 239492 <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />