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MARION COUNTY PUBLIC WORKS D ©I!I " I <br /> 4 BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE FEB 03 20216- <br /> :_.:e,ry«,4``v`" Salem OR 97305 fi ARiON COUN17 <br /> (503) 588-5147 Fax (503) 588-7948 BUILDING INSPECTION <br /> http://www.co.marion.or.us/PW/Buildinglnspection Z <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I Jill E. Von Flue, fka Jill E. Teeney , have authorized <br /> (Property Owner/Print Name) <br /> Owen Von Flue 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 /> 7755 Heinz Road NE, Silverton Oregon 97381 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 061 E210000100 Tax Lot#(s)100 <br /> PROPERTY OWNER: <br /> Printed Name: ll E. Vonl � Flue <br /> Signature: E= V6v1=/2 . Date: 1-04-2021 <br /> Address: 51 Ike Mooney Road NE Phone:503-884-2259 <br /> city, state, zipSilverton, Oregon Fax: <br /> E-mail Address mamateeney@hotmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Owen Von Flue <br /> Company Name: NO a uilt Home , <br /> Signature: Date: 1-04-2020 <br /> Address: 5146 I Mooney Road NE Phone:503-932-7698 <br /> City, State, zip Silverton, Oregon 97381 Fax: <br /> E-mail Addressvonfluelaw@hotmail.com <br /> DEQ License# NA CCB # 156990 <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />