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�� MARION COUNTY PUBLIC WORKS L '.C5D <br /> C ik <br /> MN <br /> ��� 1������'''� BUILDING INSPECTION DIVISION r�{�R.�q[ /�{�^ �/ <br /> u l�` �� 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503) 588-5147 Fax(503)588-7948 MAR 2 7 2024 <br /> ED <br /> http://www.co.marion.or.us/PW/BuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Stacey Stemach have authorized <br /> (Property Owner/Print Name) <br /> Micah Hozen. - New Creation Contracting 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 071. <br /> PROPERTY IDENTIFICATION: <br /> 1035 I North Fork Lane <br /> Property Situs or Street Address <br /> Described in the records of MARION County as: <br /> Legal Description 093E I I BBO Tax Lot#(s) 2200 <br /> Subdivision,Lot and Block <br /> PROPERTY OWNER: <br /> Printed Name: Stacey tyrnach <br /> Signature: 1 Date: 3/27/2024 <br /> Address: 1305 NW resno Ave Phone: 541-390-5134 <br /> City, State, Zip Bend, OR 97703 Fax: <br /> E-mail Address stacey(a7stemachdesign.com <br /> AUTHORIZED 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 /> City, State, Zip Halsey, Oregon, 97348 Fax: <br /> E-mail Address micah@newcreationco.net <br /> DEQ License# 38988 CCB# 201065 <br /> G:\FORMS\SEPTIC\S-07 AUTH TO APPLY.DOCX Rev 3/10,3/18 <br />