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<br /> Salem OR 57305..
<br /> MARIONI°NiC6s0p2:2c3N_TY101\1
<br /> ' ECERVE
<br /> 1503)588414T $a*,-(50,3)58$4044 .
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<br /> NOTICE.:AJTHORIZIN%REPRESENTATIVE
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<br /> /z/ , ha-e:-:414herized
<br /> ."-(Property'6vnert PriniNatne):
<br /> .:.L.1,5,effe.... .:;i4Ax.t:lt:td.4,;:,4va!-Ac-, .. ..,. ... to 4et as my agent in the
<br /> (Atithorried Representative/Print Naine)
<br /> activities:Inetes;SarytaebtAin.site evithiations,-iperrnitsatid,tither Oiiite'vliateiketer titattiterit prograin
<br /> Eseryites provided by the Department of Environmental Quality Agent on-.die property
<br /> -:deseribedbielo*in actitti:Ihrto,WithiOARChapte'f.72140.,diviSiort071...
<br /> PROPERTY IDENTIFICATION
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<br /> 'i'•?;:''. / >... •4/67/74. ..C'X'. // 14/V 0: ....:S7.4, ,:sie: if ' 3 4:iee-16 w
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<br /> And described in thereconisof:MARIONCounty as:
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<br /> itegoI Deserifition i-o: Ni..3: -V.t..Ak,.. •. . Ta.-X:1.0e.Kg) t •C;',-4 _ .
<br /> 'PROPER-117 OWNER!.
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<br /> Signature / e , - Date.
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<br /> Address ty. .V5:,.... .7.,e4tii/e /-,4:." ::' ..••:t Phone:.."7-744--i7-2-$.4..—i,*.:"`„.4R::741
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<br /> :AtrttiOkatti REPRESES-TATIVEt
<br /> Printed Name . Ci., ;-ei Ife, At'a:Al•feE- ie.1...., ,d....,5, . . . . .. .. „„ .. .
<br /> Company Nardet__,Aoc '_
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<br /> Address: .-N.: .1,ff Keel..g.:,) 4.e.. le..1. , „
<br /> City, State,Zip' tpe:ttn,43,,r,,,, 60. 1:7 t'r.'t7:. Fax
<br /> Ermoil Address tenae,
<br /> DEQ:-License4 . z7--..oro& .. . .. . „ . C.14.4 att4tack „ . . . .
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<br /> d2-10S\S6'1105-07 Autitto..4ply:doc
<br /> -14,1CS-07:Rev-03r1.0:
<br /> SEPTIC ..4,
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