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rb) ECE -NEp <br /> MARION COUNTY PUBLIC WORKS " I 0 1 2�AO <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE MARION COUNTY <br /> ' u . Salem OR 97305 `;UILD1NG INSPECTION' <br /> (503)588-5147 Fax(503)588-7948 9 _066cioqq_pOIT <br /> http://www.co.marion.or.us/PWBuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Barbara Jennings , have authorized <br /> (Property Owner/Print Name) <br /> Noble Built Homes,LLC to act as my agent in <br /> performing the(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 /> 5375 Howell Prairie Road SE, Salem,Oregon 97317 <br /> Property Situs or Street Address <br /> as:y <br /> And described in the records of MARION County <br /> Legal Description Tax Lot#(s)082W13-01200 <br /> PROPERTY OWNER: <br /> Printed Name: Barbara Jennings <br /> Signature: a,, Date: 1-25-2023 <br /> Address: 537 Myrtle Drive Phone: 503-931-6849 <br /> City, State,Zip Monmouth, Oregon Fax: NA <br /> E-mail Address Jennings.orren@gmail.com <br /> ,AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Owen Von Flue <br /> Company Name: N ble uilt Homes,L <br /> 7‹... <br /> Signature: •��� � <br /> Date: <br /> Address: P.O. Box 571 Phone: 503-932-7698 <br /> City, State,Zip Silverton,Oregon 97381 Fax: N.A. <br /> E-mail Address noblebuilthomes@<gmail.com <br /> DEQ.License# N.A. `3'20b3 CCB# 156990 <br /> G:\FORMS\SEPTICIS-07 Auth to Apply.doc `M / V <br /> CS-07 Rev 03/10 V <br />