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,�l MARION COUNTY PUBLIC WORKS �p�— <br /> ail N""' BUILDING INSPECTION DIVISION �( <br /> .. i `� 5155 Silverton Rd NE <br /> Salem OR 97305 'JULEMEn <br /> 2022 <br /> (503)588-5147 Fos (503)588-7948 <br /> ,UL2 <br /> http:/hvvtw.co.marion.onus/P«'/BuildingInspection MARION CONTY <br /> 111111111 <br /> • BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Melissa Perez ,have authorized - . <br /> Erin shelf (Property 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 /> . 871 Iva Ln NE, Salem, Or 97317 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: - <br /> Leeal Description Tax Lot#(s) <br /> PROPERTY OWNER: - <br /> Printed Name. Melissa Perez <br /> Signature:' UN Date: 6-5-22 <br /> Address: 871 Ln NE Phone:971-285-7710 <br /> City. State.Zip Salem, Or, 97317 Fax: <br /> E-mail Address melissaperez621@hotmail.com <br /> AUTHORIZED REPRESENTATIVE:, . <br /> Printed Name: Erin Sharp <br /> Company Name: E and Z Excavating LLC - <br /> Signature: Date: <br /> 6-5-22 <br /> Address: PO Box 453 Phone:971-409-7495 <br /> city, State,Zip Molalla Fax: <br /> E-mail Address erineandz@gmail.com <br /> DEQ License# 39104 CCB# 220602 <br /> (i:.FORMS SEPTIC S-07 Auth tu Apply.dou <br /> wIS-O7 Rev 03110 <br /> SEPTIC 4 <br />