|
r
<br /> Docuign Envelope ID:F5ED10EF-51A7-45BA-A42C-F63AEE3454E67
<br /> /g-003
<br /> , 1/36-_em L
<br /> ( ,
<br /> ,_ _
<br /> I
<br /> ,•
<br /> MARION COTY UNPUBLIC WORKS
<br /> .11141‘%.444444.. '
<br /> -- - :Nii --
<br /> BUILDING INSPECTION DIVISION qpciE
<br /> 5155 Silverton Rd NE
<br /> Sakti! ON 97305 1
<br /> —' MAY 07 2018
<br /> ! I
<br /> (503)5N8-514.7 Fax (503)588-7948
<br /> . rviANON COUNTY
<br /> BUILDING INSPECTION
<br /> NOTICE A'CTFIORIZING REPRESENTATIVE
<br /> . .
<br /> have authorized
<br /> Property ON\nor ' Prin't Nano
<br /> .P&TCL6K__:54,AY:51#-:
<br /> 1.,, uct zIS 711s. a.,.:;;fli III perrOin11111..! til::
<br /> Ntrti-tin-i7ci Renreen'ati-ve Print Name
<br /> jcilvi ties necessary to obtain site evaluationspermits. and other onsite wastekkatcr treatment prot.tran-:
<br /> t.:rvices provided l-). the Department of CH N ironi-nental Quaiit‘ or County Agehl on the propert
<br /> described below il accordanc-,.! with OAR chapter 340. di iso 07i.
<br /> PROPERTI IDENTIFICATION:
<br /> •
<br /> 1 127 6-A,rr.5 tiw, gi› 6,4-rt-5 c '
<br /> i(, 41.74-:%
<br /> n,_ „,,i-,..:',:i .,:.kid ftss:
<br /> Ind described in trie reeords or NIA R. ON ( unl, LH:
<br /> _
<br /> , ;..:t2a/ Description 6:41:KIMAYA1311/00.44g444,Orgrtr5450t :•_-„- :,) 6/3:1=Z7Pkeite
<br /> PROPERTY OWNER-
<br /> DocuSigned by:
<br /> C r!
<br /> i eci Name: CMS.?C,(.1.4 --2—±:c:".t,C (-: t\ C=.4414j i ) f 1, di,
<br /> Li -
<br /> ltatilrer:14-1 - -e' 1<,t__>---4L:‘"
<br /> . — ' .///7`C,‘,1,,,
<br /> __,
<br /> A1138303DE7349C . ,
<br /> \Lidress: i-j(, 3- Plione::JCH-3-_i_;---3--(-.--7_C3
<br /> •
<br /> La,.tir. , ,71 s.,.\.0_
<br /> -mail ,1cldres
<br /> 11_71-10RIZED REPRESENTATIVE:
<br /> 'rimed Name: P/Pre ICI(' rs-#E-
<br /> __
<br /> i:,flail.]I c.:.
<br /> _ _Y401477--AfrOCT.--- Date: 5/44112°
<br /> _
<br /> Adciress:
<br /> _
<br /> , it,:. State. Yip .54-t-E/S1 0 ie 1739Z--:- rav
<br /> Address f il'oet-2.5-Pyr44 ;:C004
<br /> _
<br /> DP...) ;A:clise _
<br /> ---:-
<br /> CCB ,,, - -
<br /> ---- ---
<br /> ,: !,,y..i..:‘iri,•v.- %,7,;',:.i:or.!..,',...;:i,•-..7 ;17 It`.... . ,:,',
<br /> MCS
<br /> 4
<br /> --------_----
<br /> L.. _
<br />
|