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DocuSign Envelope ID:132F6533-F72743CD-BE1B-132BF1D6C0778 <br /> MARION COUNTY PUBLIC WORKS <br /> • i1144ki,,,i.... <br /> BUILDING INSPECTION DIVISION <br /> -,-.-.--- <br /> ' ----2-------------- 7--:-"ii 5155 Silverton Rd NE <br /> NM Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> http://vvvvvv.e0.marion.orms/PW/BuildingInspection <br /> NOTICE.AUTHORIZING REPRESENTATIVE <br /> Virginia L Ripp 'Trust <br /> I, ,have authorized <br /> (Pr ertyi Or/Print Name) <br /> #--- tyg7-75.17 <br /> to act as my agent in performing the <br /> (Authorized Rep esen tive/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 /> 082W15A000600 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> cascade Vi ow Ranchets Block 1 lotLot 11 <br /> Legal Description C lifax Lot#(s) <br /> PROPERTY OWNER: <br /> Virginia L Ri pp Trust <br /> Printed lime. pcmusrgnelY: <br /> Signature: <br /> "7•*"'"" t 310 Date: 7/1/2022 1 8:49 AM PDT <br /> procarzna 1430- 3.03.508.3031 <br /> Address: 5J3Z 7011 it%v SE 4 -Conifer Circle SublimitIghEJo5 <br /> City,State,Zip sal ern OR Fax: <br /> viriPOYahoo.com <br /> E-mail Address <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: '.") t/0 4(1 (. <br /> I c c- y e-/ <br /> Company Name:11JA-S . r4.,_ te)e--t / G,-C <br /> 0 e vt. Ce, -- cl <br /> ' Signature: ( rk Date: Z Z <br /> Address: P O . 4 03X 2///b Phone: <br /> City,State,Zip lic€i`Z_ek Z,,-- 9 7- fO '1 Fax: <br /> E-mail Address pre LA.5 .... oc,fievzc_6((k5(---r-UCI-1 ;SN/4 M. <br /> DEQ License# 33- cii CCB# /6-C-S L / <br /> GAFORMSNSEPTIC13-07 Auth to Apply.doc <br /> MCS.07 Rev 03/10 <br /> SEPTIC 4 <br />