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�ll��..,,,��,�,,` MARION COUNTY PUBLIC WORKS /� ��3 // � <br /> ''�� BUILDING INSPECTION DIVISION Cam' 0 <br /> 111/0 <br /> _��jj��� �� 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 Fax(503)588-7948 <br /> http://www.co.marion.or.us/PWBuildinglnspection s \ t ''", <br /> i D <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Lori Tingley ,have authorized <br /> (Property Owner/Print Name) <br /> Katie Ryan 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 /> S..XXV\11& VA U, , e-'4?YC\ °1- 35 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description Tax Lot#(s) 008o1 <br /> PROPERTY OWNER: CPI 3 W \0 Att DD *01 <br /> Printed Name: Lori Tingley <br /> Signature: .:.,, , _ Date: February 10, 2021 <br /> Address: 10466 Sunny Side Road Phone: 503-385-8379 <br /> City, State,Zip Jefferson OR 97352 Fax: 503-385-8493 <br /> E-mail Address admin@woodrandd.corn <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Katie Ryan <br /> Company N e: ethel Excavating <br /> Signature: Date: <br /> Address: PO Box 504 Phone: 503-743-2343 <br /> City, State, Zip Turner, OR 97392 Fax: 503-743-3638 <br /> E-mail Address officebethelexc.com <br /> DEQ License# 36198 CCB # 44551 <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />