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.01 , V,,,.e.t. • . ?%11-6b 5 t 58 <br />, 41114,- MARION COUNTY.PITOLIC WORKS . <br /> BUILDINQ INSPECTION DrvisioN ECEIVED <br /> 51;55 SilverteaRti NE <br /> Saleni OR 97305 ' JUL 0 5 2024 <br /> (503)588-5147 Fax(503)588-7948 <br /> http://www:co' .mariomormstriViEnildh:mbripectian <br /> Mil <br /> NOTICE AUTHORIZING REMESENTATIVE <br /> L .<a reir L. ,CN•ct,r L 't4,- ,haVe authori2ed <br /> wo. (Property Owner"Trim Name) <br /> --Ti.S5 i's.:5es1447-4-0 tqCide /4f-taIe) to actas my agent in•perforining.the <br /> (Authorized RepresenyVe/Print NatTIO <br /> UtiVitial necessary to obtain site evaluations,permits,and other onsite wastewater tmatmentprogrant <br /> services pnavided 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 /> ( 2-.4.-il-Re .Co 2- ''° Ave, SC Sa-1 el-,1 c:Liz,.. q-73 17 <br /> Property Sitos or Stwet Address <br /> And described in the e records of MARION County.a.s: <br /> •Legal Description Tax Lot#0) <br /> PROPERTY OWNER: <br /> k.:printed Nam : Ci.re.ri L. C:No.:rc c`c..:., <br /> Signature: . - . ej...1,, Date: 676? (za w <br /> V Address 2q 1 (0 (c?2-w° ../.4.Y'r SE phone:. so$ (4 I is 0 2 p.7 <br /> i''CitY)State,.Zip S -te:etwl 0.A... CI-7 ..5/7 . . Pax; . It <br /> or E-rnoil Address k'el.r•t_1,/ .... L— G a r-.G.;mP. 1-%c):416,\is;L. cc <br /> AUTHORIZED REPRESENTATIVE': <br /> Printed Name: 07e 5_5 .5-4-44411, <br /> Company Name: 4C't.;.(fit Pro:till , - • •: . a, <br /> / . <br /> .. . el ... <br /> Signature: Date: 7/(Uid <br /> Addtes • 3470 /(64:miy- . ..;'f ,5_.4 Phone:503 - 73'2--ZOi <br /> City,State,Zip S tz le 141 Og 77317 Fax 5.63 - $7,5*" ,SI 0 / <br /> E-mail AddrM jr. a C#1.0it4q;c1 3 wq;;./.. cool <br /> DEQ License* 3.‘32.3 CO3 it <br /> G;WCipaNSEFOCS307 Auth-to Appli.dge <br /> IvICS,07 Rev 03/10 <br /> SEPTIC 4 <br />