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MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> $155 Riverton Rd NE <br /> Went OR 97305 <br /> (503)588-5147 -PRI(503)588-7048 JUN 1 5 2021 <br /> http://yvww.comarlon.ar.usiPW/Buildinginspecilon MARION COUNTY <br /> BUILDING INSPECTION <br /> NOTICE:AUTHORIZING REPRESENTATIVE <br /> 1)6r2/2-(..k_ STaf-S. ,have authorized. <br /> (tioperty Owner Ptint Name) <br /> TYL •to act as my agent performing-the <br /> (Authorized 1epieSentative/Print Name) <br /> activities necessary to Obtain site evaluations,permits,and other onsitewastewater treatmentprogram <br /> services provided by the Department of Environmental Quality or County Agent on the property <br /> described below hi accordance with OAR chapter 340,division 071, <br /> PRQPERTY IDENTIFICATTON: <br /> TD,277t4-0,—,— CA- cC-1-Scl <br /> Property Situs or$tlIbt Address <br /> And described in the records of MARION County as: <br /> Legal Description Talt 1.44t <br /> pRprogree0ER: <br /> Printed Name:. cs-r(-ms <br /> Signature: Date: igftk. <br /> Address: Phone: q--)( ioc)- <br /> city,state,zip ca. 0,--),)-) Fax: <br /> E-mail.Address ktsio s-T-4-rey-4 d2vhd.,( <br /> AUTHORIZED RF,PRESEFTATIVE: <br /> Prititect,Naine: tt Dret- <br /> Company Naniej,. <br /> Signoture: -7 " Date: U-1\-1 41t, <br /> AddresS: 0 vT14ione: 23 9 9j 103 <br /> City,State,zip S(),M,he\ M Fax: <br /> E-mail Address V-01 CCI Ca cast_- <br /> DEQ License# -7)0 '.-3) ceB# 4Y31 <br /> GAPORMSWEPTICS-07 Met to Apply.doo <br /> MCS-07:Rev 03/10 <br /> SEPTIC, 4 <br />