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Atk ` MARION COUNTY PUBLIC WORKS 0 LA <br /> ,dl nue <br /> BUILDING INSPECTION DIVISION RECEIVE, <br /> 5155 Silverton Rd NE <br /> no- Salem OR 97305 Apo 15 2024 <br /> (503) 588-5147 Fax(503)588-7948 <br /> http://www.co.marion.or.us/PWBuildinglnspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Scott Henry 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 /> 3868 Riverdale Rd. Salem, Oregon 97302 <br /> - Property Situs br Street Address <br /> Described in the records of MARION County as: <br /> Legal Description 083W06DC 00900 Tax Lot#(s) 00900 <br /> Subdivision, Lot and Block <br /> PROPERTY OWNER: <br /> Scott Henry <br /> Printed Name: <br /> Signature: jaee W Date: 4/13/2024 <br /> 3868 Riverdale rd. south <br /> Address: Phone: 503-327-5563 <br /> City, State, Zip Salem,Oregon 97302 Fax: <br /> E-mail Address Scotthenry75@gmai 1.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 />