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MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Siivertoa Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> http://www.co.marion.or.us/PWBuildingInspection �� <br /> JUL 2 6 2024 <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> Dottie Farnsworth ,have authorized <br /> (Property Owner/Print Name) <br /> Lii'Stinky Environmental Service,Inc. 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 /> 13722 Heather Ln NE Aurora OR <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 /> Printed Name: Dottie Farnsworth <br /> Signature: DvGie -fcrn.S'v.1(-4- Date: Jul 172024 <br /> Address: 13722 Heather In NE Phone: 50341347752 <br /> City, State,Zip Aurora Oregon 97002 Fax: <br /> E-mail Address farnsworthdottie@gmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: ( f S CIO-Se n <br /> Company Name: Lit Stinky Environmental Service,Inc. <br /> Signature: � � Date: 7/19/2 y <br /> Address: c(,(DZ\ Jo1.0\ - ',r; Phone: EDa35l Q715 <br /> City, State,Zip CWeckon C Fax: <br /> E-mail Address ,/.;-\ l i ��„� k. . <br /> DEQ License# '}— 1< CCB# <br /> G:IFORMSISEPTICIS-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />