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DocuSign Envelope ID:BEEFO7A9-5652-42C1-83A4-03D5E75EFC6C <br /> Uocu (gn tnveIope Iu:(.::341M4uti-1-u44-4r5a-nAa-tb&W-;ul5a1L;i <br /> `'"a MARION COUNTY PUBLIC WORKS <br /> .III ��� BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE <br /> Salem OR 973.05 <br /> (503)588-5147 Fax (503)588-7948 <br /> http://www.co.marion.or.us/PW/BuildingInspection <br /> • <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> D&D Frank Family LLC/Dennis Frank have authorized <br /> (Property Owner/Print Name) <br /> Best Septic Inc Rep Haylie Conley 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 /> 8637 Silver Falls Hwy SE Aumsville OR 97325 <br /> Property Situs or Street Address <br /> Described in the records of MARION County as: <br /> Legal Description 082W130000 00'\ DO Tax Lot#(s) <br /> Subdivision,Lot and Block <br /> PROPERTY OWNER: <br /> Printed Na ee: EtikEoftimik Family LLC/Dennis Frank <br /> Signature: l )t,litkLiS c'raiAkDate: 12/19/2022 <br /> • .,c.,o3rrour4ca,.. <br /> Address:PO BOX 79 Phone:•503-931-4313 <br /> City,State,Zip Mill City, OR 97360 Fax: <br /> E-mail Address <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Haylie Conley <br /> Campany�t� (-AMCII q <br /> Signature: Date: I Q?' A-1 L RA <br /> Address: )x zfdGOO Phone:541-484-U844 <br /> City,State, Zip Eugene OR 97404 Fax: <br /> E-mail Address installs@bestsepticpumping.com <br /> DEQ License# 37467 CCB# 153656 <br /> G:IFORMS\SEPTIC\S-07 AUTH TO APPLY,DOCX Rev 3/10.3.-l8 <br />