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bb-olu.5 <br /> f", ECEIVED <br /> MARION COUNTY PUBLIC WORKS <br /> BUILDLNG INSPECTION DIVISION <br /> 5155 Silverton Rd NE APR 23 2024 <br /> • Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> http://www.en.man'on.or.us/PW/BuildingInspectum <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 1201-Ni N j Lee— / have authorized <br /> ow <br /> "(Property cr rint N ): <br /> Micah Hozen - New Creation Contracting to act as my agent in performing the <br /> (Authorized Representative/Etint 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 /> • .72 —5 r-AelliM <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 /> Printed Name: <br /> Signature: Date: 2(2/ZY <br /> Address: 6, 72 Sit< hIsi-r. Phone: <br /> Pho - ni-3/27 <br /> City,State,ZipSo-teriN(C)A - tr/30k <br /> Fax: <br /> E-mail Address <br /> UTHORIZED REPRESENTATIVE: <br /> Printed Name: Micah Hozen <br /> Company Name: New Creation Contracting,. <br /> Signature: Date: 2/7/2024 <br /> Address: 31366 Oak Plain Dr, Phone:503-710-2565 <br /> z' Halsey, Oregon, 97348 <br /> City State, ipFax <br /> E-mail Address micah@newcreationco.net <br /> OE4Itc'ense# 38988 CCB# 201065 <br /> 4 • <br /> s'•• FoRAs'' sem 7 mini TO APPLY'°°"Rcv 311%3115 <br />