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2g- G-v S7 S-7 E viq-L <br /> ECE <br /> MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE O C T <br /> Salem OR.97305 <br /> (503)508-5147 Fax(503)588-7948 MARION COUNTY <br /> http://wwew.co.marion.or.us/PW/BuildhngInspection <br /> BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 1, Heidi Kincaid ,liave authorized <br /> (Property Owner!Print Name) <br /> Flow Line Construction LLC 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 /> 15962 Stormy Drive NE, Silverton, OR 97381 <br /> Property Sites or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description BERRY MEADOWS LOT 9 fax Lot#(s) 071 E060002900 <br /> PROPERTY OWNER: <br /> Printed Name: Heidi Kincaid <br /> + Date: 1 O/11./23 <br /> Signature: >.—e.JL'` 1... vU`C.L <br /> Address: 4136 Forest Ridge Rd. NE Phone:(503) 873-3003 <br /> City,State,Zip Silverton, OR 97381 Fax: <br /> E-mail AadresskincaidihCErontier.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Trey Renoud <br /> Company Name: Flow Line Construction LLC <br /> Signature: Date: 10/11/23 <br /> Address: Phone: <br /> 11805 State St 503-871-2260 <br /> City,state,zipSalem, Or, 97317 Fax: <br /> E-mail Address Construction.flowiine@gmaii.com <br /> DEQ License#39474 CCB#.239492 <br /> G:\FORMS\SEPTTC\S-07 Auth to Appty.doc <br /> MCS•07 Rev 03/10 <br /> SEPTIC 4 <br />