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. <br /> ; t ,, MARION COUNTY PUBLIC WORKS <br /> 'a,,; BUILDING INSPECTIQN DIVISION <br /> �_ .—,� .�. a a ley a- <br /> ... 5155s e, n:RdNE ® .CC ECvif [7{)`\ <br /> ..,,,,.` Salem OR 97305 y , <br /> (503)5s$-5147 Fax(503)sss-794s 'JUL 2 6 2022 <br /> http /ww co iniarion or us/PW/Bufldin Inspection <br /> MARION COUNTY <br /> BUILDING INSPECTIO. <br /> NOTICE AUT' #ORIZING REPRESENTATIVE;; . <br /> Barbara Ni' utst <br /> •,•: h Y9 ,have authorized • <br /> . • (Property t}vtr•ner I Print Name) <br /> Casey Crosland CAC�ccavation Inc. <br /> : .. .. to•aetas my agent in performing the <br /> (Authorized.Repiese tahue/Print Name)` <br /> activities:necessary xo obtain site evaluations,permits,-and other onsite wastewater t-eatment.program,. <br /> se vices,`provtaed by t'4 e Departmen:t:of Environmental Qw hity.or unty Agerit-on the`pr"ope rty <br /> described.below ii a666i4 ice with;QAIt:c aptet 340,divisioi 071.. <br /> PROPERTY Ei4t ICATION ; <br /> 20265 Butteviile Road NE, Hubbard, OR.97032 , <br /> Property: '.sittisi,cit Street Address <br /> And described in-the.records::of NIARION:County-as: <br /> Legal Descnption.NE 114 sec 19 T4S RIW�,WM. vlano•n County Tax Lt•t,#(s)041WI9A ►0900` . <br /> PROPERTY.OWNER:, <br /> .. Printed Name, <br /> Barbara Nyqutst <br /> Signature t ,t . / Date 7/1`212022. - . <br /> A950 N Cas ade Dr le:Pi::;' r Address: 3 - 'Phone.50. - 7G ►52 <br /> City;State, cp <br /> Woodbum, OR.9707.1 <br /> E-mail '40-14s4+ crates a6 atia + rat - . - <br /> AI'llIORIZED PRESENTATIVE <br /> Printed a•me.. • <br /> Casey++I;ro .1.6. nd <br /> CQtnpariy Maine <br /> CA Excavation C c <br /> ;Sgnature • Date <br /> ..Addrss :P. O .Box 81 ,. -. .- Phone.503-55Q 6408 <br /> C Dayton, OOR 9711°4 <br /> ty,Stafie„Ztp< . .. .. . _ .: . Pad.. <br /> E=ma;1 AddressCACEXING@OUtl0Ok;cote <br /> : '. DEQ License#: ..7 S0 V CCB 221�i19 <br /> . G.W ORMS\SEPTics .:7*ihhto.Appfydac: <br /> • <br /> NMCs-Q7 Rgv-pa ll? -- <br /> $EPTic • • • 4 <br />