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2 if—t 3 S PP-Mr <br /> �,�, MARION COUNTY PUBLIC WORKS.(�I •a'w�`)' BUILDING INSPECTION DIVISION <br /> 115C[FINED <br /> - 5155 Silverton Rd NE lij <br /> 11AY 0 v 2024 <br /> Salem OR 97305 <br /> . 'p'' `' j' (503) 588-5147 Fax (503)588-7948 iViARION COUNTY <br /> , "` htip://www.co.Marion.or.us/PW/Iluildinglnspcction BUILDING INSPECTION <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I. - --aD!JPr r Rt'cA S_,_ A►ldftY , have authorized <br /> (Property (hvner/ Print Name) <br /> Josh Hansen ( Oregon Sewer & Drain LLC) to act aS Illy agent in performing the <br /> (Authorized RepresentatiVC/ Print Name) <br /> activities necessary to obtain site evaluations. permits, and other onsile 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 /> 1.3.(6(0 R,`LheS , KS o. s, l Vertm -02 c1.73 x(— - — <br /> Property Situs or Street Address • <br /> And described in the records of MARION County as: <br /> Legal Description T75'post And a __------.. .------.- fax Lot il(S)-7 } 600 <br /> PROPERTY OWNER: <br /> Printed Name: _-?,,U re.S_. rarn,1 --. -_f-d0)s r , G— --- <br /> Si�unaturc: —_ _� W — - - — — — Date: --- —� <br /> Address: 13 f(91 le,i, S_itd S e Phone: S 0 - e Z_I-ogG Z. <br /> City. State. Zip _5,1t/e-,1}Or/l S2 q-7-jS1— — Pax:-- <br /> E-mail Address_Cob tf`OCtil PSSee Ist_d-o`1 — — — — <br /> AU'1'ltORIZED REPRESENTATI VE: <br /> Printed Name: Josh Hansen — -- — — __— <br /> Company Name: Oregon ewe & Dr 'n LLC -- <br /> Sitnature: - - Date: 5 fig — — <br /> Address: _ PO Bo 1 — — — -- phone: 503-874-9414 <br /> City, State. Zip_ Silverton, OR 97381 ' _—_ I:ax:_ _- <br /> E-mail Address josh@oregonsewer.com <br /> — <br /> DIiQ License it 38968 CCI3 II 201683 _-- -- <br /> (i .fOR\IS',SI;VI ICS-U?:\ud)to:\ppI .d"c <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />