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(93 06?%5SP 17 <br /> MARION COUNTY PUBLIC WORKS E C E I V E -1 <br /> ') <br /> BUILDING INSPECTION DIVISION -� <br /> � 555 Court St.NE Room 2260/PO Box 14500 - --� <br /> DEC '�� �n�� <br /> Salem OR 97309-5036 <br /> (503)588-5147 Fax(503)588-7948 MARION COUNTY <br /> http://publicworks.co.marion.or.us/building/ BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Karl W. Knoll ,have authorized <br /> (Property Owner/Print Name) <br /> Todd Zollinger to act as my agent in performing the <br /> (Authorized Representative I 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 /> 3224 Crooked Finger Rd. NE <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description Tax Lot#(s)072E08 00200 <br /> PROPERTY OWNER: <br /> Printed Name: Karl W. Knoll <br /> Signature: /C/ / Date: 12/5/2023 <br /> Address: 3224 Crooked Finger Rd. NE Phone:503-873-1939 <br /> City, State,Zip.Scotts Mills, OR, Fax: <br /> E-mail Address karch_01@yahoo.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Todd Zollinger <br /> Company Name: Zollinger Excavating, Inc. <br /> Signature: o C - Date: /7--/r/2- <br /> Addless. 6771 Peter Rd E Phone: <br /> City, State,Zip Aumsville, OR 97325 Fax: <br /> E-mail Address %/M z & Co#"t <br /> DEQ License# 3 6 7'/. CCB# 72 037 <br /> G:\FORM.SISEPTICIS-07 Auth to Apply.doc <br /> MCS-07 Rev 03/07 <br /> SEPTIC 4 <br />