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MARION COUNTY PUBLIC WORKS <br /> "''i. BUILDING INSPECTION DIVISION <br /> ,dl <br /> �--/`-al 5155 Silverton Rd NE <br /> am. . ' ' Salem OR 97305 <br /> (503) 588-5147 Fax(503)588-7948 <br /> http://www.co.marion.or.us/PW/Buildinglnspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Tim Kahle , 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 /> 11078 Dogwood Lane SE Lyons, Oregon 97358 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description Tax Lot#(s) 093E18BA00100 <br /> PROPERTY OWNER: <br /> Printed Name: Tim Kahle <br /> Signature: / -B Xc Date: 1/7/2021 <br /> Address: 1690 E ene Court NE Phone: 971-209-9202 <br /> City, State,Zip Keizer, OR 97303 Fax: <br /> E-mail Address kahlebuildersllc@gmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Katie Ryan <br /> Company N m : the Excavatin <br /> Signature: (, ,t� 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 officeabethelexc.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 />