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• <br /> MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silvertan Rd NE. RECEIVED <br /> IMI_ .....„ , Salem OR 97305 <br /> (503)588-5147 Fax (503)588-7948 JUL 26 2024 <br /> . 1 http://www.comarion.orms/PW/Buildinginspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I,, Ve.e"le.xs •ear4,1„,0 tel V1,,t 41e4e—‘- ,.have authorized, <br /> (ProRerty Owner{Print Name) <br /> 'ta.win 1 GT-0 Noetovii; k.,4 C)c c"vp,,koto,act-as my agent in performing the <br /> Ltirf(Aett"-hofizedReeresentatrelive Print Name)-3 <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 /> 44(,04 (dfxrvt,‘ek, oK gi-.35-c? <br /> Prolperty Sails or Street Address <br /> And described in the records of MARION County as: <br /> Lep]Description Tax Lot#(s) <br /> PROPERTY OWNER: <br /> Printed N e: Dennis Bartholomew <br /> Silflatitre: bd,-...A .1 .3.111471040--1-1 Date: 07/12/2024 <br /> 49770 N Santiam Hwy <br /> Address: Phone: 503-854-3185 <br /> Idanha Oregon 97350 <br /> City,State,Zip Fax <br /> Bartnor2@hotmail.com <br /> E-mail Address <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: •6LA.. ..;,,‘ <br /> Company Na c <br /> Na :. 14-a ,,tA",d loilAft. CX_CAMatati 0or' <br /> Signature: /--1-/-- Date: 07/12/2024 <br /> Address: g-0- 130( (011) Phone:. 51)3- 8 gq-6 Zil 0, , <br /> City, State,Zip (.,toyti., 0 e_ q q-35 a Fax: i44 , <br /> E-mail Address f5eL._ eipt4.., I. 111&N <br /> DEQ License# A 9 lei t CCB# 2.11 1-li <br /> GnfOlUt&S,SEPTICS-07 Auth to 4ply.doc <br /> MCS-07 Reit03/10 <br /> SEPTIC 4 <br /> • <br />