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di/e.,• :,,;N,,,i..... MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> • 5155 Silverton Rd NE <br /> i Salem OR 97305 <br /> --" (503)588-5147 Fax(503)588-7948 <br /> http://www.co.marion.arats/PW/Buildinglitspection <br /> '. . NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Is.0 a, w Nem 1:1_,ekrssi,kx_ have authorized <br /> (Property Owner/Print Name). <br /> Micah Hozen - New Creation Contracting 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 /> III 1748 & 1808 Farmer Rd SE Jefferson, Oregon 97352 <br /> Described in the records of MARION County as: <br /> Legal Description Zre,fLt./ .4e4r..z.i t`gir#11-3 Tax Lot#(s) 26 0 <br /> Subdivision,Lot and Block <br /> PROPERTY OWNER: <br /> Printed Name: Le)ts- ,E-II ell Pe,a_ rs.0 ift_ <br /> Signature: 412... 6 ieg-r-ILLA,4,„-_. Date: if4(1?/ ..3 <br /> Address: .471:9 77 r--4..... C4-, 4/E. Phone: SO 3—5,5al zi-e' <br /> City,State,Zip .5-61.1vt) DP., 9 73 oi Fax: <br /> E-mail Address P I c.Ill 0 a p (0 CO Yr 6 a S"1... kit+ <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Micah Hozen <br /> Company Name: New Creation Contracting <br /> Signature: --P Date 7/6/2023 <br /> Address:.. 51366, ()CIL e t o IV\ 0 r--- Phone: 503-710-2565 <br /> City,State,Zip W:45e -i _ 'Oregon 973 915-- Fax <br /> E-mail Address Micah @neworeationco.net <br /> DEQ License# 38988 CCB# 201065 <br /> G:WORDASSF.PTIOS-07 Atillt To APPLY.DOCX Rev 3/10,3/Is <br />