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DigiSign Verified-980b41d7-d91a-4176-84e1-a60b5ebb219a <br /> t MARION COUNTY PUBLIC WORKS <br /> 011 "'l BUILDING INSPECTION DIVISION a3-(`���-{,3i0 <br /> �il��, 5155 Silverton Rd NE RE C E v <br /> E 1 <br /> iiiSalem OR 97305 <br /> (503)588-5147 Fax(503) 588-7948 OCT 05 2023 <br /> http://www.co.marion.or.us/PW/BuildingInspection <br /> MARION COUNTY <br /> BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 1 ',John Fredrick Lytle Jr & Kinsey McPhie Lytle ,have authorized <br /> Try—� (Property Owner/�'int Namelrl <br /> OC.SS ►.$ei# .i , ,�I G /CI Qi yj to act as my agent in performing the <br /> (Authorized Represent Y ve/Print ame) <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 /> k7057 Rosedale Ln S Salem, OR 97306 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description Tax Lot#(s) <br /> PROPERTY OWNER: <br /> kPrinted Name: John Fredrick Lytle Jr Kinsey Mcphie Lytle <br /> a( Signature: Joky Age/Rick 4ileJi Kindest ANcPEti641 Date: to/04/a023 <br /> t <br /> r Address: 7057 Rosedale Ln Phone: <br /> (801) 637-6062 <br /> Lir City, State,ZipS Salem, OR 97306 Fax: l <br /> ot- E-mail Address j ohn1985@out look. com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: ., -e 55 t\. •se-1244 T <br /> 1 Company Name: 4t.7 i M cc i <br /> Signature: Date: 7/o /i 6 <br /> Addres O I Phone:550 3- q3i-zvoJ <br /> City, State,Zip 5 Q/e 144, 01 9 73I7 Fax: SQ 3 - c.P5- 2'v�D1 <br /> E-mail Address y. Q C/'l on irq; A-)3 mqi 1. corn <br /> DEQ License# 31(3z3 CCB# 50/7/ <br /> G:\FORMS\SEPTICIS-07 Audi to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br /> i <br />