Laserfiche WebLink
MARION COUNTY PUBLIC WORKS Lkeso 3.-71g <br /> BUILDING:INSPECTION DIVISION <br /> 5155 iNverton.Rd NE RECEIVED <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> APR 0 9 2024 <br /> 111M1 vvww.co.marion.dr.usIPW/Buildinginspection <br /> • NOTICE AUTHORISING REPRESENTATIVE <br /> • L Mary Campos <br /> ,have authorized <br /> •,,, • - wner/P...t ame) <br /> 0," Tz,a el I t; to act as ray agent in performing the <br /> (Authorized 'epresentative/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 /> 15214 Woodburn Monitor Rd, Woodburn Or 97071 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal.Description Tax Lot#(s)051W25DC01500 <br /> PROPERTY OWNER: <br /> Printed Name: Mary Campos <br /> Signature: -A Date: <br /> Address: 15214 Woodburn Monitor Rd ' <br /> Phone 5o5, ft5- t 47 <br /> City,State,Zip Woodburn Or 97071 Fax: <br /> E-mail Address WU 04,4a roil OnOtti,i30/2-610.1.• 60/11 <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Charlie Bennett <br /> Company Name: Bennett Septic Service.LLC <br /> Signature: <br /> Date: 3--27 Z.4 <br /> Address: Po.Box 551 Phone:503-829-4452 <br /> City,State,Zip Molalla Or 97038 Fax: <br /> E-mail Address bennettsepticservicellc@gmail.cOrn <br /> DEQ License# 39252 CCB# .246581 <br /> GAFORMS\SEPTICIApplimition Packet.0-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC <br /> 4 <br />