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r <br /> MARION COUNTY PUBLIC WORKS <br /> ,11 F ` <br /> „Ho BUILDING INSPECTION DIVISION <br /> �'�`'��''- 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 . <br /> http://www.co.marion.or.us/PW/BuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, AMANDA M. BEADLE ,have authorized <br /> —�- (Property Owner/Print Nameirl <br /> ..J e-Ss �•$Z q ,t' ,4 cii L? to act as my agent in performing the <br /> (Authorized Represen� wive/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 /> k 7129 JUNIPER STREET NORTHEAST, SALEM, OREGON 97305 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: V. <br /> Legal Description T :7 RNG:2W LGL DSC:J HOWELL DLC Tax Lot#(s)0729W030000400 <br /> PROPERTY OWNER: <br /> k Printed Name: AMANDA M. ��%" .BEADL <br /> l Signature: Date: 04/30/2024It <br /> 6r Address: 2164 HEATHER STONE CT NE Phone: (503) 516-4522 4-? <br /> City, State,Zip KEIZER, OREGON 97303 Fax: t <br /> t E-ma l Address ABEADLE@HOTMAIL.COM <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: J -1 55 V. .St---,1441,1 <br /> Company Name: G ,' 4 1rq; <br /> Signature: �- - - Date: ?PAW/6 <br /> Address` 3� D ./(c' h 14i;civiitor <br /> qv' 6 Phone:5D 3- ?32.-;'{DJ <br /> City, State,Zip 5 Q1e km J Di ! 73/7 Fax: c©3 - $8 - Oil <br /> E-mail Address it''', Q ct lon drq;t D3 i' q 1. C e m <br /> DEQ License# 3.W3Z3 CCB# 500/ <br /> Gf FORMSLSEPTICCS-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />