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Docusign Envelope ID:F268568B-6D9F-4C76-AD33-BA67EAF73220 aL r o S9 <br /> ;'. MARION COUNTY PUBLIC WORKS RECEIVED <br /> �" BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE AUG 19 2024 <br /> Salem OR 97305 <br /> (503) 588-5147 Fax(503)588-7948 <br /> http://www.co.marion.or.us/PW/Buildinglnspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Joseph Foti a ,have authorized <br /> (Property Owner/Print Name) <br /> Josh Hansen ( Oregon Sewer& Drain 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 /> 16025 Stormy Dr NE, Silverton, OR 97381 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 071E06D001300 Tax Lot#(s) 538355 <br /> PROPERTY OWNER: <br /> Printed Name: Joseph Foti a <br /> ClactaikSignature:C���, Flti Date:3/16/2024 I 5:47 PM PDT <br /> w�uFeiwTux3._ <br /> Address: 16772 Moody circle, Apt C Phone: (714) 718-6149 <br /> City, State,Zip Hunti ngton Beach, CA 92649 Fax: <br /> E-mail Address jsfoti a@gmai l.cam <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Josh Hansen <br /> Company Name: Orego w Drai LLC <br /> Signature: Date: <br /> Address: PO 1 2 Phone: 503-874-9414 <br /> City, State,Zip Silverton, OR 97381 Fax: <br /> E-mail Address josh@oregonsewer.com <br /> DEQ License# 38968 CCB# 201683 <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />