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07D- bbg <br /> D EC-EWE —I <br /> it- ) <br /> - NOV 13 2020 — <br /> MARION COUNTY PUBLIC WORKS MARION COUNTY <br /> 1r <br /> 1111' BUILDING INSPECTION DIVISION BUILDING NSPECno ) <br /> 5155 Silvertoa Rd:NE <br /> -- <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> http://www.eo.marion.or.us/PW/BuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> L - ety-C:c1... DY"-ki ,have authorized <br /> (Property Owner/Print Name) <br /> Tony L Collins 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 /> 997W lane ne salem 97317 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 2 parcel Tax Lot#(072w20d2300 <br /> PROPERTY OWNER: <br /> printed Name: CA*11 S-1:1(16k- <br /> Signature: le- _5k-1g/el- Date: )0— g-0 <br /> Address: tJA;4eld AL-kr" tie Phone: S 010L/D <br /> City,State,Zip S oe--- 41-9-3as-Fax: <br /> E-mail Address C1,--.5eIrC :9- iv") <br /> AUTHORIZED REPRESENTATIVE: <br /> • Printed Name: Tony L Collins <br /> Company Name: TLC <br /> Signature: /6445.../..-Criar4i. Date: 10-12-2020 <br /> Address: P° ba 962 phone:503-689-3872 <br /> city,state,zip Walla Oregon 97038 Fax: <br /> E-mail Address angelkt63@hotmailcom <br /> DEQ License#37966 CCB#R1667 <br /> Gt‘FORMSSEPTICS-07 Auth to Apply.dos <br /> MCS437 Rev 03110 <br /> SEPTIC 4 <br />