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",, MARION COUNTY PUBLIC WORKS - .19_ 1 2 2021 <br /> ‘�� "" BUILDING INSPECTION DIVISION <br /> �i �� 5155 Silverton Rd NE <br /> MARION COUNTY <br /> ing.. -. _,,, ., - Salem OR 97305 ' BUILDING INSPECTION <br /> (503)588-5147 Fax(503)588-7948 <br /> http://www.co.marion.or.us/PWBuildinglnspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, A. Charles Sheketoff ,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 /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 14388 Evans Valley Rd NE Silverton Tax Lot#(s) 061W35D001300 <br /> PROPERTY OWNER: <br /> Printed Name: A. Charles Sheketoff <br /> Signature: i r. Date: 7/9/2021 <br /> Gam/ <br /> Address: 14388 Evans Va ey Rif r Phone: <br /> 503-507-5631 <br /> City, State,Zip Silverton OR 97381 Fax: <br /> E-mail Address chuck.sheketoff@gmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Katie Ryan <br /> Company Nam` : hel Excavating <br /> Signature:'. . Date: 0 9 1 <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(p�bethelexc.corn <br /> DEQ License# 36198 CCB# 44551 <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />