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MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> s 5155 Silverton Rd NE <br /> Salem OR 97305 <br /> (503)588-5147 Fax(503)588-7948 <br /> http://www.co.marion.or.us/PWBuildinglnspection <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> Timothy and Lisa.Schurter <br /> I, ,have authorized <br /> SPronerty Owner/Print Name) <br /> Nathan Soderman of Michael J.Pa Iska, c 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 /> 5174 SHANNON ROAD NE;SILVERTON,OR 97381 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> ACRES 9.09 071W06 00200 <br /> Legal Description Tax Lot#(s) <br /> PROPERTY OWNER: <br /> Pted Ne Timothy and Lisa Schurter <br /> rinam <br /> Sgnature4`iftAp' Date: <br /> Address: 5174 SHAN N ROAD NE <br /> Phone: (503)932-8007 <br /> SILVERTON,OR 97381 <br /> City, State,Zip Fax: <br /> E-mail Address <br /> AUTHORIZED REPRESENTATIVE: <br /> Nathan Bodemian <br /> Printed Name: <br /> Michael J.Paluska,PC <br /> Company Name: <br /> Signature: Date: <br /> 1820.Commercial Street S.E. (503)999-3801 <br /> Address: Phone: <br /> City, State,Zip Salem,OR 97302 Fax: <br /> E-mail.Address b°der,@n°email.°om <br /> DEQ License# CCB# <br /> G:\FORMS\SEPTIC\5-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />