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MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION "Th <br /> 5155 Silvertoa Rd NE <br /> Salem OR 9730S <br /> (503)588-5147 Fax(503)188,7948 AUG 11 2023 <br /> • http://www.eomarian.or.us/PW/Buildinbispeetion <br /> • MARION COUNTY <br /> BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> David Holloway ,have authorized. <br /> (Property Owner/PrintName) <br /> Lill,Stinky Environmental Service,Inc. 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 07 L <br /> PROPERTY IDENTIFICATION: <br /> 3095 Molalla Rd,Woodburn,OR 97071 <br /> Property Situs-or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 05110 lab Tax Lot#(s) CC8rr) <br /> PROPERTY OWNER: <br /> Printed Name: David Holloway <br /> Signature: P°t-i4 °6 Date: Jul 14 2023 <br /> Address: 3095...acia wr.Molalia Rd Phone: 808-212-8967 <br /> City,State,WP41514.6W6R Fax: <br /> E-mail Address Davicirholloway86@gmailcom <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: <br /> Company Name: Lil'Stinky Environmental SerVice,Inc. <br /> Signature: ( Date: Jul.14 2023 14:09 PDT <br /> Address: la(03k‘Aotair Phone: CoL33S f8715 <br /> City,State,Zip C Fax: <br /> E-mail Address <br /> DEQ License# gp32.31 CCB# <br /> GAFORMSVSEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev WO <br /> SEPTIC 4 <br />