Laserfiche WebLink
AL. <br /> MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silvertan Rd NE <br /> EN Fin <br /> 1111111111 Salem OR 97305 <br /> (503) 588-5147 Fax(503)588-7948 <br /> httpiftwww.eu.marion.or.us/PW/13aildinf,Inspection ij MAY 19 2023 <br /> MARION COUNTY <br /> BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 1, Sarah DuPont , have authorized <br /> çPropertyr'ner I Printt, Name) <br /> I .e.,r 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 /> q9 ba-tt S 12CLS • C(k.L44ek c1-1-3L1 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description T 3k.,t3 SEC_?A Lot#(s) -}C -- <br /> PROPERTY OWNER: . <br /> Printed Name: Sarah DuPont <br /> Sianarure:Sank 1;tott DamQ4/17/2023 <br /> Address: 7490 Bates Rd S Phone:503-931-6706 <br /> City,State,Zip Satem OR 97306 Fax: NA <br /> E-mail Address dupont1322@yahoo.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: 0%1(1 CWO <br /> Company : `C. LC- <br /> Signature: Date: .(trii.1 <br /> Address: 4d Is t/lye- Phone: 6.'W-.9 Z 9-ecie5/ <br /> City,State,Zip nycerrp 72, 4 7 3 22. Fax: <br /> E-mail Address Pt - - 4-16— ( 4k-fivtre./ / CC)4--) <br /> DEQ License# 3 03-* CCB # / 56-c-2 <br /> G‘FORMS1SEPTIOS-07 Atte to Apply dm <br /> 1/ICS-07 Rev 03/10 <br /> SEPTIC 4 <br />