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k MARION COUNTY PUBLIC WORKS <br /> ��I "" BUILDING INSPECTION DIVISION <br /> • / . 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 Fax(503) 588-7948 <br /> www.co.marion.or.us/PWBuildinanspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 36th St Property LLC , have authorized <br /> (Property Owner/Print Name) <br /> Richard Kraft 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 /> 5144 36th Ave SE <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 08 2W 18B Tax Lot#(s) 1000 <br /> PROPERTY OWNER: <br /> Printed Name: 36th St Property LLC -Richard Kraft <br /> Signature: /gCf A - Date: 10/02/2023 <br /> Address:36t I_266FKashmir Way SE Phone: 503.364.3103 <br /> City, State,Zip Salem, OR 97317 Fax: <br /> E-mail Address richard@kraftmasonyinc.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: <br /> Company Name: <br /> Signature: Date: <br /> Address: Phone: <br /> City, State,Zip Fax: <br /> E-mail Address <br /> DEQ License# CCB # <br /> G:WORMS\SEPTIC\Application Packets\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />