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11 <br /> -r=i 3C-11-\ <br /> „1 4k.,„,,� MARION COUNTY PUBLIC WORKS �O ECEeVED <br /> BUILDING INSPECTION DIVISION <br /> =� �w 5155 Silverton Rd NE <br /> Salem OR 97305 �•Pt 011014 <br /> um.-,,,,„„,,,, (503)588-5147 Fax(503)588-7948 . <br /> http://www.co.marion.or.us/PW/BuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 4c I, AMANDA M. BEADLE ,have authorized <br /> --�i �p (Property Owner/Print Name <br /> rJr5 iC...5e#141 if 4C f Ci/ jJ( 4 to act as my agent in performing the <br /> (Authorized Represent lve/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 /> c 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 TWN:7 RNG:2W LGL DSC:J HOWELL DLC Tax Lot#(s)0729W030000400 <br /> PROPERTY OWNER: <br /> k Printed Name: AMANDA M. BEADL „;, , <br /> i( Signature: i�G /k / % Date: 04/30/2024 <br /> r Address: 2164 HEATHER STONE CT NE Phone:(503)516-4522 4 <br /> 41-City, State,Zip KEIZER, OREGON 97303 Fax: ' <br /> e E-mail Address ABEADLE@HOTMAIL.COM <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: J e 55 '. . t---1949.11C7 <br /> Company Name: G i' b1 Y4 i <br /> Signature: Date: 7/OS/I d <br /> Addres . 300 I"17,S4 m i>- 5 Phone:5 03 73 .-2+"i <br /> City, State,Zip 5 ql e 144 i 01 q 73/7 Fax:.CO 3 - c P d v�dq <br /> E-mail Address j . Q c-/'ioi4 otf q {t ) pi i 1. L o$1 <br /> DEQ License# J 3 3Z.3 CCB# 50/7/ <br /> G:1FORMS1SEPTICVS-07 Auth to Apply:doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />