Laserfiche WebLink
0-co\\. ao <br /> MARION COUNTY PUBLIC WORKS RECENED <br /> BUILDING INSPECTION DIVISION <br /> --�•��� �`�� 5155 Silverton Rd NE FEB 13 2019 <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 MARION COUNTY <br /> http://www.co.marion.or.us/PW/Buildinglnspection 3UILDING INSPECTION <br /> f NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Lhe e L• T ot/vACO 1' ,have authorized <br /> (Property Owner/Print Name) <br /> Katie Ryan 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 /> 23 5 l7 ,Ss a,Vial ji EuAti . 4_i ms, ('/� 9 7358 <br /> Property Situ'or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description SV/Mit ark A\Q,mi��' (i Tax Lot#(s) / &/'75c) A t'( 3/, 1. 61c1-732- <br /> PROPERTY <br /> .61132.PROPERTY OWNER: <br /> Printed Name: AA _a '�lg° • *VA rr fl <br /> Signature: *-10 Lc i l 4-� Date: t -'t - /9 <br /> Address: ,/ et IG • Phone: 54/ 4072 -530 r <br /> City,State,Zip_KQSe\ot l ) 01< 977 ) Fax: <br /> E-mail Address i, <br /> �/]k,, l (�1'L V� O i l Cj{'I A I/ cam <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Katie Ryan <br /> Company e:. Bethel E avating <br /> Signature. I ``��� Date: \ r\.01 <br /> Address: PO Box 504 Phone: 503-743-2343 <br /> City,State,Zip Turner, OR 97392 Fax: 503-743-3638 <br /> E-mail Address office& bethelexc.com <br /> DEQ License# 36198 CCB# 44551 <br /> G:IFORMSISEPTICIS-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br /> l of 1 2/12/2019,2:24 PM <br />