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a --..co9 i - °1\ <br /> ......., <br /> 'n , -, _., <br /> MARION COUNTY PUBLIC WORKS NOV 2 8 20i,i <br /> 411 +++4j+� BUILDING INSPECTION DIVISION <br /> �—otJ <br /> T 5155 Silverton Rd NE <br /> Salem OR 97305 + + _ ++O of <br /> MI/ (503)588-5147 Faxs/ (503)588-7948 <br /> http.J/w(50 )588-5ion.orFax 03)5 din948 ection <br /> i <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I ieffr/`� gr 79--J 1e,‘#( y 43r'a-6Cjrpr,s(- have authorized <br /> (Property Owner/Print Name) <br /> Brannon Lamp,REHS—Aqua Resource Design&Consulting, 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 /> I 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 /> 110 Lake St. E. Detroit,OR 97342 <br /> Property Situs or Street Address <br /> Described in the records of 114ARION County as: <br /> Legal Description T1OS, R5E,Sec.1CD Tax Lot#(s)1300 <br /> Subdivision,Lot and Block <br /> PROPERTY OWNER: <br /> Printed Name: Robert&Nancy Bradford <br /> Signature: _ /yam Date://72.74,'a't--3 <br /> Address: P.O.Box 691 503-991-9985 or 503-5O7-5o48 <br /> Phone: <br /> v <br /> City,State,Zip Slayton,OR 97383 <br /> Fax: <br /> E-mail Address bbradford2558@gmait.com <br /> 1 <br /> 1 <br /> A LITHORIZED REPRESENTATIVE: <br /> Printed Name. Brannon t,arnp, ftrli 4 <br /> one tn� Name: 4 u a _ _p >tc n onsutttn LLC <br /> p �, A �.a��esovtc�, �,�' <br /> _ ._�_Date: 11121/23 <br /> Ad:lCfi _`" - <br /> 3 9 M1, nGy Iv 65 <br /> _ ...- _� Phone:O3-922 2149 <br /> 4 tt1,State:Zap_p Portland C3R97232 <br /> Fay <br /> ,�-mail Address I1rannonab -- __ - <br /> qua r,�sctt:rce.�.otr, <br /> DEC)I icense;:F <br /> f p,issEpT:es:7A6-iii'ioxit'i'r.Y.Ix'4:,„R,,xrir},yin _ <br />