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MARION COUNTY PUBLIC WORKS <br /> ”0: BUILDING INSPECTION DIVISION <br /> • •• <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503).588-5147 Fax(503)588-7948 <br /> http://www.ca.marian.or.us/PW/BuildingInspeetion <br /> • <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> L Steve Bryant, President, Elkhorn Coporation ,have authorized <br /> (Property Owner I Print Name) <br /> Don Harrold,Builder 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 /> 34885 North Fork Rd., Lyons, OR 97358 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 084E310000100 Tax Lot#(s)1°° <br /> PROPERTY OWNER: <br /> Printed Name: Steve Bryan President, Elkhorn Corporation <br /> ce**72 Signature: Date: August 2, 2021 <br /> / <br /> Address: 6 63 Seventh MntaIK Dr phone:541-619-3964 <br /> City, State,zipPend, OR 97702 Fax: <br /> E-mail Address bendbryants©gmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: ,b;.)1\) 14 \&OLO <br /> Company Nam PAJ <br /> Signature: Date: 8 <br /> Address: ps-ty-2_, A04/0..) c_r Phone: 3-6E- S-9--S1/ 9 <br /> City,State,Zip SI4 LE-44 / 973)7 Fax: <br /> E-mail Address qv-Inse_, C7413 vvo I- I 0 C() <br /> DEQ License# CCB# 2_G-390 <br /> 0:\Foitms\sEpros.07Auth to Apply <br /> MCS.07 Rev 03/10 <br /> SEPTIC_ 4 <br />