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� ,�� <br /> g-09-532J-7g-09-532J�\�� <br /> MARION COUNTY PUBLIC WORKS � H All INSPECTION DIVISION o\2 <br /> -��j����,�. 5155 Silverton Rd NE \�' <br /> Salem OR 97305 CAS <br /> (503)588-5147 Fax(503)588-7948 <br /> Idtp://www.co.marion.or.us/PW/BuildingInspection oa <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> 1, �Alic T Vise/KA/0 ,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 /> Z?512 Aide (vA y/ Rd SE cf 1e_-,/ at? 973/7 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> `' Legal Description -7-"RS; R71/4C, ,lEr o A Tax Lot#(s) 3S0043L00 <br /> PROPERTY^OWNER: <br /> Printed Name: )a0 id T. evAAAFt ,tA J <br /> Signatur ...)„..,7? ��>,.>,.v„.._— Date: 4//L//7 <br /> Address: ,25,9S-�/�i 3-C o v y /n./ jr9x/3/7 Phone: ;47 t' c 09,2'7 <br /> City,State,Zip ,-/2(,0,vA j cc-IR x'(7317 Fax: A4 A <br /> E-mail Address 1-6lit.tiel I fti'lct c' MsAI Cotl1 <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Josh Hansen <br /> Company Name: 0 on r rain LLC <br /> Signature: / Date: Z-g--r-7 <br /> Address: PO ox 282 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 /> OWORMS\SEYTICCS-07 Auth to Apply doe <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />