Laserfiche WebLink
�`��1j�� MARION COUNTY PUBLIC WORKS ��� <br /> ��I ��`''' BUILDING INSPECTION DIVISION a <br /> %��� �� 5155 Silverton Rd NE 11 <br /> Salem OR 97305 U t_; -` • <br /> (503) 588-5147 Fax(503) 588-7948 � ®�c 012,02� <br /> ' <br /> WWW.CO.marion.or.us/PW/BuildingInspection <br /> 1/\BiC�1' Z° �' <br /> Buil-M31ti 1 �� 1.0 1 ON <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Rodney Schlenker , have authorized <br /> (Property Owner/Print Name) <br /> Alain Rebeyrol,Architect 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 /> 605 S Pacific,Woodburn, OR 97411 <br /> Property Situs or Street Address <br /> • And described in the records of MARION County as: <br /> Legal Description 051 W18D Tax Lot#(s)000300, 000400. 000500, 000600 <br /> PROPERTY OWNER: <br /> Printed Name: Rodney Schlenker <br /> Signature: /eev ; / Date: 10/14/22 <br /> Address: Two Westb iok Corporate Center , Ste 500 Phone: 224.500.8633 <br /> City, State,Zip Westchester, IL 60154 Fax: <br /> E-mail Address rschlenker@iaai.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: ALAIN REBEYROL EUGENE, OR 97401 <br /> Company Name: COMPOSITE ARCHITECTURE, LLC <br /> Signature: Date: <br /> Address: 30 E BROADWAY, SUITE 151 Phone: 541-683-5762 <br /> City, State, Zip EUGENE, OR 97401 Fax: <br /> E-mail Address REBEYROL@COMPOSITEARCHITECTURE.NET <br /> DEQ Liccn3c# CCB ItOregon State Board of Architect License:ARI-5395- <br /> G:\FORMS\SEPTIC\Application Packets\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />