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•� a L <br /> L UI.I/JIgll-ClIVCIUIIC IL/.C.QU4Ul7 l,*J 1- triter• :JLLM/RUC I'<rJM.11CPS <br /> `►:+,�;1 t MARION COUNTY PUBLIC WORKS <br /> li <br /> ili 1"'t BUILDING INSPECTION.DIVISION <br /> r�`'E- �: 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 . Fax(503)5814-7948 <br /> www.co.manion.or.us/PW/BuildnaInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Bunnie Reed , have authorized <br /> (Property Owner/Print Name) <br /> Erin Sharp/E and Z Excavating LLC 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 /> 871 Iva Ln NE, Salem, Ora? <br /> Property Skits or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description Tax Lot#(s) <br /> PROPERTY OWNER: <br /> Printed Name!:t.e wB�etufwnw�nx1i.e Reed <br /> Signature: �/.y,, ., C CkprLAstDate: 2-20-22 <br /> Address: ?L4E 9731 Phone: <br /> City, State,Zip Salem, OR, - Fax: <br /> E-mail Address <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Erin Sharp/ E and Z Excavating LLC <br /> Company Name: E and Z Excavating LLC <br /> Signature: Date: 2-20-22 <br /> Address: PO Box 453 Phone: <br /> City, State,Zip Molalla, OR 97308 Fax: <br /> E-mail Address erineandz@gmail.com <br /> DEQ License# #39104 CCB# 220602 <br /> G_1FORMS\SEPTICApplication Packets\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />