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Page 2 of 4 <br /> DocuSIgn Envelope ID:02BFF405-0231-4DEB-8A7E-D70072240ADg <br /> MARION COUNTY PUBLIC WORKS <br /> Ill ' 7BUILDING INSPECTION DIVISION <br /> i <br /> —= " 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588x147 Fax(503)588-7948 <br /> www.co.marion.or.us/PWBuildingInspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Randy Weitman .have authorized <br /> Joshua Percy (Property Owner I Print Name) <br /> • 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 /> 8522 okey Ln. SE, Turner, OR 97392 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description ACRES 0.73 Tax Lot#(s) R35623 <br /> . PROPERTY OWNER: <br /> Randy Weitman <br /> Printed Name ,,r <br /> Signature UJ tux. Date: 4/30/2019 10:43 AM PDT <br /> Address: I'm`' SE Phone: <br /> City,State,Zip Turner, OR 97392 Fax: <br /> E-mail Address rneitman@wavecable.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Joshua Percy <br /> Company Narisae*e+by, <br /> Signature: jtS{Uw.Ptroi Date: 4/30/2019 1 11:29 AM PDT <br /> Address: 11:12122.ffff85' iuey ct SE Phone:503-990-5971 <br /> City,State,Zip Turner, oR 97392 Fax: <br /> E-mail Address joshpercyl@gmai l.com <br /> DEQ License# n/a CCB# n/a <br /> n rORMS1SEPtIC Appiicaliam Pad2tiS47Auth to Apply doc <br /> i 1CS 07 Rev 03/10 <br /> SEPTIC 4 <br /> about:blank 4/30/2019 <br />