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MARION COUNTY PUBLIC WORKS ibC <br /> BUILDING INSPECTION DIVISION APR 21 2023 <br /> 5155 Silverton Rd NE Salem OR 97305 MARION COUNTY <br /> (503) 588-5147 Fax (503) 588-7948 3UILDING INSPECTION <br /> http://www.co.marion.or.us/PWBuildinglnspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 1 Peter J Brentano and Wendy L Brentano,Trustees of the Peter J&Wendy L Brentano Living Trust have authorized <br /> (Property Owner/ Print Name) <br /> %-4\ Ukrit.es 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 /> 3217 Horseshoe Lake Rd NE, St Paul, OR 97137 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: Cc o+titi,4,Aec,._See cz.ttu Lhr;41) <br /> Legal Description Beginning at a point 5.80 chains South of the... Tax Lot#(S)043VV24A001000 <br /> PROPERTY OWNER: <br /> Printed Name: Pete Brentano <br /> Signature: ' ' Date: 4/21/2023 <br /> Address: PO Box 275, 217 Horseshoe Lake Rd NE Phone:503-932-2370 <br /> City, State, ZipSt Paul, OR 97137 Fax: n.a. <br /> E-mail Address Pete@brentanos-treefarm.com <br /> AUTHORIZED REPRESENTATIVE: <br /> I - ' t <br /> Printed Name: pi,% ; 1W 1 I NYL ,eS <br /> Company Name: Pji..( ; ` Aid 1 (✓ E(c_ L L - <br /> Signature: Date: el/ay /.2 <br /> ' <br /> Address: �() & )( 6 ( Phone: $"G3 --3 4q - 'o 7 <br /> City, State, Zip L✓ j J S(N 116 () r q�Ga 7 b Fax:S o 3 — (7s-- 32 .3` <br /> E-mail Address o Cl �1 .� �N a L< d r/ C' 01,4 <br /> c Y <br /> DEQ License# 3,522 (f 6 CCB # <br /> G:\FORMS\SEPTIC\5-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />