Laserfiche WebLink
,111 ;,,,,,,i MARION COUNTY PUBLIC WORKSp.7gia <br /> .. actor <br /> BUILDINGMSS INSPECTIRd n <br /> ON DIVISION CEi�c <br /> NE <br /> Salem OR 97303 <br /> (503)588-5147 Fax(503)588-7948 AUG 0 8101�f <br /> http://www.co.marion.or.us/PW/BuildingInspeetion <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> A izY C ASrL. <br /> have authorized <br /> (Property Owner/Print Name) <br /> Herbert Wilson.Jr/Lone Pine Corner Septice.Inc <br /> (Authorizedto act as my agent in performing the <br /> 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 /> f7,50A Pn C2c=g L PNe <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description SSE se, <( 1-isZ I E Taxarar <br /> PROPERTY OWNER: <br /> Printed Name: M AIZ (' - <br /> Signature. Date: 61512 <br /> Address: 17S? Powces CP-Pitt 1,P /4 Phone: Sy/-5 SY—973g <br /> City,State,Zip i)up,, r.t C(� q Zg el Fax: <br /> E--mail Address maru3, sAI•ee b.i Y . CO tin <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Herbert C Wilson,Jr <br /> Company Name: Lone Pine Corner Septics, Inc <br /> signature: ,��_7�20,4y Date: <br /> Address: 8778 Cascade Hwy NE :503-87 <br /> Phone. 3-7157 <br /> City,state,Zip Silverton, OR 97381 Fax:503-873-5562 <br /> E-mail Address LonePineSeptics8778@gmail.com <br /> DEQ License# 37003& RI-100 CCR it 177063 <br /> GAFORMASEPi7CW.07 Auth to Apply.dou <br /> MCS-07 Rei►03/10 <br /> SEPTIC <br /> 4 <br />