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• <br /> DocuSign Envelope ID:7758938C-7DAE-4880-9D96-88F8F404C70A <br /> • MARION COUNTY PUBLIC WORKS <br /> it. BUILDING INSPECTION DIVISION p`c <br /> l`�� �� 5155 Silverton Rd NE 9' <br /> ,, `l <br /> 'r.2 .�g ; Salem OR 97305 ECENET) <br /> (503)588-5147 Fax(503)588-7948 • L <br /> http://www:co.marion.or.us/PWBuilding,Inspec• n mAR 0 4 nu <br /> MARIONINOUNTY <br /> SPECTION <br /> IL.D1 <br /> NOTICE AUTHORIZING REPRESENTA'1'1V +' <br /> . Jason S Carlile ,have authorized <br /> • (Property Owner/Print Name) • <br /> =- +. Drew Colyer to act as my agent in performing the <br /> • <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 /> • <br /> • PROPERTY IDENTIFICATION: <br /> 3915 Cloverdale Dr SE Turner. OR 97392 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description P.p. 2001-101, Parcel 1, Acres 6.82 Tax Lot#(s) R61302 <br /> . PROPERTY OWNER: <br /> • <br /> PrintedName: Jason S Carlile <br /> 1/27/2022 112.41:45 PM PST <br /> Signature: ��,� S ( Date: , <br /> • <br /> Address: 975 w Arnaz St. Phone: 541-990-9332 <br /> City, State,Zip Meridian, Idaho 83646 Fax: <br /> E-mail Address j asons Carl i l e@gmai 1.com <br /> • <br /> AUTHORIZED REPRESENTATIVE: <br /> • <br /> Printed Name: ') t e_vo <br /> Company Name: n t R Nei( (1.0 IA S r t 9 r1—(o Vl • ` <br /> Signature: Date: 2/ Z YZ Z <br /> Address: P.c) p X 7rr((ST) Phone: <CD E 9 9' (856, <br /> City, State,Zip Ice s�L r CJ r g 7zo -7 Fax: <br /> E-mail Address . c P_ nw e✓lC)U\IToci-[ O 12 11A .C <br /> DEQ License# CCB# 76 S 36, I <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />