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• DigiSign Verified-f1 bcbf6e-16e3-4a44-9e4c-c945675633bc <br /> ��� MARION CO TY PUBLIC WORKS <br /> ,1� <br /> 141e BUILDING I SPECTION DIVISION <br /> 5155 ilverton Rd NE <br /> - _- Sa •mOR97305 <br /> 11111111/ (503)588-51.7 Fax(503) 588-7948 <br /> http://wvvw.co.marioi.or.us/PW/BuildingInspection <br /> NOTICE AUTHOil' ZING REPRESENTATIVE <br /> I, Eric Larson Cas- dra Larson have authorized <br /> (Property Owner/Print lame) <br /> Lee Bethel-Bethel Excavating to act as my agent in performing the <br /> (Authorized Representative/Print Nam,) <br /> activities necessary to obtain site evaluations, .ermits, and other onsite wastewater treatment program <br /> services provided by the Department of Envi onmental Quality or County Agent on the property <br /> described below in accordance with OAR chapt-r 340, division 071. <br /> PROPERTY IDENTIFICATION: <br /> Z0610 Bridge Creek Road, Si1v-rton OR 97381 <br /> Property Si i s or Street Address <br /> Described in the records of MARION County a : <br /> Legal Description Tax Lot#(s) <br /> Subdivision,Lot and Block <br /> PROPERTY OWNER: <br /> Printed Name: Eric Larson, Casandra Larson <br /> Signature: Szic-1[cvrzon. Casa/day,damson, Date: 07/01/2024, 08:15:45 AM PDT <br /> Address: 11880 NW 43rd Street Phone: 503-932-2614, 503-507-7999 <br /> City, State, Zip Terrebonne OR 97760 Fax: <br /> E-mail Address ec.larson1970@gmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Lee Bethel <br /> Company Name: Bethel Excavating <br /> Signature: _ Date: -1- \-7-0ZL-' <br /> Address: PO Box.504-6976 Little Rd SE Phone: 503-743-2343 <br /> City, State,Zip Turner, OR 97392 Fax: NA <br /> E-mail Address office@bethelexc.com <br /> DEQ License# 36198 CCB# 44551 <br /> G:\FORMS\SEPTICVS-07 AUTH TO APPLY.DOCX Rev 3/10,3/18 <br />