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�'" MARION COUNTY PUBLIC WORKS (� �, Q�� <br /> ,��i ,11j������ BUILDING INSPECTION DIVISION _ I O�U <br /> iiim% <br /> y��%��� 5155 Silverton Rd NE i1 v <br /> �X Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 IT <br /> APR 10 2U24 <br /> http://www.co.marion.or.us%PWBuildinglnspection • <br /> MARION COUNTY <br /> BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, ►Wc`vi L\'— have authorized <br /> (Property Owner/Print Name) <br /> Lee Bethel-Bethel Excavating 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 /> rtr1 Ne) 1,f t \ l c -: ` M, ,7- Ufa.G118ziz <br /> Property Situs or Street Address <br /> Described in the records of MARION County as: <br /> Legal Description PP `ZOZ3- 012., Ltd-- 2_ Tax Lot#(s) Qc - (..- b <br /> Subdivision,Lot and Block �2 � � <br /> PROPERTY OWNER: <br /> Printed Name: Rpc\sr.c.k,G Lec k c <br /> Signature: go-•AS,vct� Z Date: �'j�j,2_L-� <br /> �)Ua-, <br /> Address: -I I iv LU\ Phone:_ �(gj <br /> City, State,Zi ') L_ Fax: Nil <br /> E-mail Address <br /> AUT +ORIZEI)REPRESENTATIVE: <br /> Printed Name: Lee Bethel <br /> Company Name: Bethel Excavating <br /> Signature: Date: <br /> PO Box 504-6976 Little Rd SE <br /> Address: Phone: 503-743-2343 <br /> City, State,Zip Turner, OR 97392 Fat: NA <br /> E-mail Address office@bethelexc.com <br /> DEQ License-4 36198 CCB# 44551 <br /> G:\FORIvIS\SEPTIC\S-07 AUTH TO APPLY.DOCX Rev 3/10,3/18 <br />