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DocuSIgn Envelope ID:B516DDBD-4AD5-4F35-9E78-6B8C46C223EA <br /> • 2 3_o r o 413 Pl►eit4 r <br /> MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION v <br /> 5155 Silverton Rd NE <br /> 111111111111111 Salem OR 97305 1 7 J <br /> (503) 588-5147 Fax(503)588-7948 L I '— f• 9 J 2g21 <br /> http://www.co.marion.or.us/PW/BuildingInspection <br /> MARION COUNTY <br /> ROWING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> Jeanette Neliton <br /> I, have authorized <br /> (Property Owner/Print Name) <br /> Lee Bethel-Bethel Excavating 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 /> Liq 2 if Real Rock in S Sot /CM ae <br /> PropertY Situs or Street Address <br /> Described in the records of MARION County as: <br /> Legal Description Tax Lot*(s) <br /> Subdivision,Lot and Block <br /> PROPERTY OWNER: <br /> Jeanette Neliton <br /> Printed cuslgned by: <br /> Signatur : i:.a+ALtk MtifbVt. Date: 12/27/2023 <br /> 2502477CB42F43B... <br /> Address: 4977 Red Rock Ln S Phone: 503-508-9510 <br /> City, State,Zip Salem, OR 97302 Fax: <br /> E-mail Address jeanetten@dogarbage.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Lee Bethel <br /> Company Name: Bethel Excavating <br /> Signature: Date: <br /> Address: PO Box 504-6976 Little Rd SE Phone: 503-743-2343 <br /> City, State, Zip Turner,OR 97392 Fax: NA <br /> E-mail Address office@bethelexc.com <br /> DEQ License# 36198 CCB# 44551 <br /> G:WORMS\SEPTIC\S-07 AUTH TO APPLY.DOCX Rev 3/10,3/18 <br />