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MARION COUNTY PUBLIC WORKS <br /> E 11V E 7\ <br /> .,i1101411K 464., <br /> BUILDING INSPECTION DIVISION <br /> -I <br /> 5155 Silverton Rd NE NOV 15 2021 <br /> Salem OR 97305 <br /> ° <br /> (503)588-5147 Fax(503)588-7948 MARION COUNTY <br /> ° http://www.co.marion.or.us/PW/BuildingInspeetion BUILDING INSPECTION <br /> NOTICE AUTIIORIZING REPRESENTATIVE <br /> Acta I 1, ,have authorized <br /> (Property caner/Print Name) <br /> Dan Williams - Faster Permits 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 /> 35414 Francis St SE Lyons, OR 97358 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 084E32BD Tax Lot#(s) 01500 <br /> PROPERTY OWNER: <br /> Printed Name: e- <br /> ... 6 <br /> Signature: _ Date: f A3/2 / <br /> Address: V61,-- 6 to rue...a. ii. Phone: 3.3z-7 7 f-70,3 <br /> City, State,Zip_jc.,.LL.12.13l; 7X 71410 ( Fax:7 3-2247-7 75-0 <br /> E-mail Address fini 41za al. 114we, e 5 pi aka. <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Dan Williams <br /> Company Name: Faster permits <br /> Signature:__p /AIt/oU.----' Date: 11/12/21 <br /> Address: 000 SW 1st Ave, Suite 420 Phone: 503-819-7754 <br /> City,State,Zip Portland, OR 97201 Fax: <br /> E-mail Address dan@fasterpermits.com <br /> DEQ License# CCB# <br /> Gf‘FORIASISEPTICS-07 Auth to Apply.tioc <br /> MCS-07 Rev 03110 <br /> SEPTIC 4 <br />