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aL-11- aPlitrAS <br /> ,i11 ‘ik • <br /> MARION COUNTY PUBLIC WORKS <br /> "" BUILDING INSPECTION DIVISION <br /> r1�% 5155 Sihverton Rd NE �,a <br /> • ¢ as",. Salem OR 97305 RECE F9 ED <br /> (503)588=5147 Fax(503)5884948 <br /> http://www.co.marion.orms/PW/BuildingInspection JUN 21 21324 <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> r, Nicholas Erickson <br /> , have authorized <br /> (Property Owner/Print Name) <br /> Lil'Stinky Environmental Service,Inc. to act as my agent in performing the <br /> (Authorized Representative f PrintName) <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 /> 11509 Arabian Lane Northeast Hubbard,OR 97032. <br /> Property Situs or Street Address <br /> And described in the records of MARION County_as: <br /> Legal Description Tax Lot#(s). <br /> PROPERTY OWNER: <br /> Printed Name: Nicholas Erickson' <br /> Signature: `N Date: Jun 05 2024 <br /> Address: 11509 Arabian Ln NE Phone: 503-333-2552 <br /> City, State,Zip Hubbard,OR 97032 Fax: <br /> E-mail Address nick_ericksonl2@yahoo;corn <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: <br /> Company Name: Lil'Stinky Environmental!Service,Inc. <br /> Signature: CC/" Date: <br /> yCOC 2l <br /> Cif <br /> Address: lc b k L o\cky 1111.. Phone: 'O SSt 6115 <br /> City,State,.Zip: 0 1n Cl C` C Fax: <br /> E-mail Address 'r- {�r v j C-C) <br /> DEQ License# R61AI CCB# <br /> GGFORMS\SEPTIC1S-07 Aut6 to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />