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..., w�.� .r. ... �..�.. ... . __ _... _._....__. <br /> � MARION COUNTY PUBLIC WORKS <br /> 'III ii"'' BUILDING INSPECTION DIVISION <br /> l` 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 AUTHORIZING REPRESENTATIVE <br /> Carlos Garcia <br /> I, ,have authorized <br /> Ken Tooze ExcavatibPri operty Owner/Print Name) <br /> 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 /> 8212 Davis Ridge Rd SE, Aumsville, OR 97325 <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 /> Carlos Garcia <br /> Printed Name: <br /> Signature: °s Arax Date: 7/12/2024 <br /> Address: 8212 Parcel #2 Davis Ridge Phone: 5039308603 <br /> City, State,Zip Aumsville, OR 97325 Fax: <br /> E-mail Address rcgarci3@yahoo.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Ken Tooze <br /> Printed Name: <br /> Ken Tooze <br /> Company Ti qlgaVcuSigned by: <br /> Kw Tooyc. 7/12/2024 <br /> Signature: t Date: <br /> 862 " ac nawk. T <br /> Address: Phone: <br /> City, State,Zip 97316 Fax: <br /> kwtexcavation@aol .com <br /> E-mail Address <br /> DEQ License# 39231 _ CCB # 165848 <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC, 4 <br />