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a416,• , MARION COUNTY PUBLIC WORKS <br /> " 00,"" BUILDING INSPECTION DIVISION <br /> iN 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> http://.www.co.marion.or.us/PW/BuildingInspection <br /> NOTICE AUTIIORJ1J1NG R1 PKE LITATIY1 <br /> I, Christopher M.Briola-President of CMB Construction,Inc. have authorized <br /> (Property Owner/Print Name) • <br /> Herbert C. Wilson, Jr. & Lone Pine Corner Septics, Inc. 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 /> • <br /> PROPERTY IDENTIFICATION: - <br /> 123 E.Sorbine AVE . Gates,Oregon 97346 <br /> Property Situs or Street Address . " <br /> • <br /> Described in the records of MARION County as: <br /> Legal Description Davis&Park Subdivision Block 1 Lot FR 7 Tax Lot#(s) 093E26CC01800 <br /> Subdivision,Lot and Block <br /> PROPERTY OWNER: <br /> Printed Name: Christopher M.Briola - President of CMB Construction,Inc. <br /> Signature:L' . aia&--P4,24,;,&tt-6:g Cyta c6 Date: 02-17-2023 <br /> Address: 1098 Brunner Ct.NE Phone: 503-569-5869 <br /> City, State,Zip Keizer,Oregon 97303 Fax <br /> E-mail Address cmbriola@live.com <br /> AUTHORT7,F,D REPRESENTATIVE: <br /> Printed Name: Herbert C. Wilson, Jr. <br /> Company Name:_Lone Pine Corner Septics, Inc. <br /> Signature: 14.1eviVes& C .�k,/ ( p Date:a,->1.7 -a <br /> Address: 8778 Cascade Hwy. NE. Phone: 503- 873- 7157 <br /> City, State, Zip"- Silverton, OR 97381 Fax: 503-873 -5562, s <br /> E-mail Address LonePineSeptics8778@gmaii.com <br /> DEQ License# 37003 R-I-100 CCB# 177063 <br /> • <br /> G:'FORMSISEPTICIS-07 AUTH TO APPLY.DOCX Rev 3/10,3/18 • <br />