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DocuSign Envelope ID:C5C78F02-5698 4586-AE10-79ACAD5C9458 <br /> ���, MARION COUNTY PUBLIC WORKS <br /> ail <br /> tagtom BUILDING INSPECTION DIVISI.ON <br /> -..d►� e---1.1111 <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 Fax (503)588-7948 <br /> wvvw.co.marion.or.us/PW/BuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Agafia Kalugin,Trustee of the Kalugin Family Trust ,have authorized <br /> (Property Owner/Print Name) <br /> Erin Sharp, E and Z Excavating 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 /> 91101) £r7715Parr Rd. NE, Gervais OR 97026 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Parcel 2, Partition Plat 2017-054, recorded November <br /> Legal Description06, 2017 in the Book of Partition Plats as Reel Tax Lot#(s) 1001 <br /> 4012, Page 357, Film Records, Marion County, Oregon. <br /> PROPERTY OWNER: <br /> Printed w Agafa Kalugin,Trustee of the Kalugin Family Trust <br /> Y <br /> Signs eci5ti'' E5la(fa azii, Date: 3/15/2022 <br /> E059a115C94B0... <br /> Address: 10807 Duck Inn Rd. SE Phone: <br /> City, State,Zip Brooks, OR 97305 Fax: <br /> E-mail Address dani el_kal ugi n@yahoo.com ` <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Erin Sharp <br /> Comps bv.E and Z Excavating <br /> Signa re tt&. SLOr Date: 3/16/2022 <br /> F1313329C3AF45£.. <br /> Address: PO Box 453 Phone: 971.409,7495 <br /> Molalla, OR 97038 <br /> City,State,Zip Fax: <br /> E-mail Address erineandz@gmail.com <br /> DEQ License# DEQ#39104 CCB# CCB#220602 <br /> G:\FORMS\SEPTIC\Application Packets\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />