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MARION COUNTY PUBLIC WORKS <br /> .... <br /> BUILDING INSPECTION DIVISION <br /> ,.-- ., 5155-Silvetto0 Rd NE <br /> ,.,.r.,-, , . Salem OR 97305 <br /> (503)$88-5147 Fax(503)508-79.48: <br /> ipw../B dito <br /> http://www. ,comarion.orius nil nspection <br /> . : ... <br /> . _,. <br /> NOTICE AurticiRIZING It.EPRESENTATIVE. <br /> 1, •kYleluran <br /> '-'• . „ ,have authorized <br /> (Property Owner/Print Name); <br /> OWEN CONSTRUCTION . -to act as my agent in performing the <br /> (Authaiiied.Repre4entatiye-i Print Istairte) <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.onthe property <br /> described below inaco:witance with OARehapter 340,diviiion-071. <br /> PROPERTY IDENTIFICATION' <br /> 310 toitileist-N Detroit OR silia. . . . <br /> ' - Proetty Sito or Street-Address• ' <br /> And described in:the-record§of'MARION County as: <br /> ., ___ <br /> LegatDescription!AlvIMONO A5DiTION BLOCK 3 LOT 5 Tax tOt AS) 103E0iBdtiT900 <br /> PROPERTY OWNER: <br /> Printed 14ame: If*Iuran <br /> sipature. .. , 10444.x. _, . Ate: 8/02/2,02 <br /> . , , , . , <br /> . <br /> Address.: 4195.Pir 10..l.N. , hone. 503,510,8023 ' <br /> , . . <br /> City,State,Zip -1(EIZER OR-97303. . _Fax: <br /> E-mail Address f Kyle@ rem odelkelzer.corn <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed-Nnme.. d/1-8.,i4) 0 e <br /> 1_ <br /> , , , <br /> cdnipatiy.Name- - btt.,,m.i.",_ 1,,.‘...4-ft IC I—,Its i.,..- , <br /> Sigliatgre;i . bate-: 7e`,/ <br /> . - <br /> ... <br /> Adaresst. . -, .x 1.(1 <-..c. Phone: ct5 3 qt-ici' tg3 E. <br /> City,State,Zip k ci:'8...e.-__r Or Fax <br /> E-mail Adclrea <br /> DEQ License* 1sq co# irs G <br /> 0 9RMS‘SEPTi6s4/Autitt9,40y.dtic . <br /> MC4::(57 Rey ptio- . <br /> swnt 4, <br />