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A .-4673-AAE1-A9DBB8175CBD <br /> MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> • 5155 Silverton Rd NE <br /> •.' wa�.eno Salem OR 97305 <br /> (503) 588-5147 Fax (503) 588-7948 <br /> http://www.co.marion.or.us/PW/BuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I RPM Construction Ron McKenzie , have authorized <br /> (Property Owner/Print Name) <br /> Bethel Excavating_ to act as my <br /> agent in performing the <br /> (Authorized Representative/Print Name) <br /> activities necessary to obtain site evaluations,permits, and other onsite wastewater treatment <br /> program services provided by the Department of Environmental Quality or County Agent on the <br /> property described below in accordance with OAR chapter 340,division 071. <br /> PROPERTY IDENTIFICATION: 1 y \ot,l �U� \ <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: 6°13 WC p \' <br /> Legal Description 251 Kens Way S Salem OR 97306 Tax Lot#(s) <br /> PROPERTY OWNER: <br /> Printed N •ciisillEM Construction LLC Ron McKenzie <br /> Signature Date: 12/8/2021 <br /> 8A0159F2F23E419... <br /> Address: 475 McNary Ave NW Phone: 503 8810909 <br /> City,State,Zip Salem,OR 97304 Fax: <br /> E-mail Address rsaproperties*live.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: \U��� _ <br /> Company Na e: <br /> Signature: Date: <br /> Address: Po / 67( _50 4/ Phone: ,�j �l�-(3 a3(-( <br /> City, State, Zip 771K/l/e.X', �?'7.>/Q2. Fax: `�— <br /> E-mail Address c e6.36e fr7e/e <br /> DEQ License# 3 / 9 0 CCB # 4(4 Ss I <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />