Laserfiche WebLink
k' MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> �r� <br /> � : v 5155 Maarten Rd NE <br /> .. - Salem OR 97305 <br /> (503)588-5141 Fax(503)588-7948 <br /> _ http://www.ea.marlas.or.ns/PW/Raildinglaspeetiea <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, am_f R. 40 1t et_ L i tit n ' t +qqrh � have authorized <br /> Owner/Print Nadirs <br /> ) <br /> Tyler Fuhriman <br /> Y 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 /> /aQ 7.1 our 7 e -.Cf. A/. i 4r-a; /- <br /> - - - ----Property Srius of Street Address -------- <br /> Described in the records of MARION County as: <br /> Legal Description m.4A(e'19..1 1 E'/O,/4/Y)Tax Lot#(s)Ic .EOI Be o4//O) <br /> Subdivision,Lot and Stock <br /> ,PROPERTY 9WNER: . <br /> Printed Name. J R. 11,.ce) L.7 <br /> Signature: Rives'� Date: 0._96./Pe2 0.2 y <br /> Address: 30493 3)f f,..t letZ i A Phone:5Y/•)..13-13X 2. <br /> City,state,Zip rzseekii_I i r% OF. Q?333 Fax: <br /> E-mail Address help>i G 5 Lnel-t <br /> I AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Tyler Fuhriman <br /> Company Name: Fuhriman Septic Design & Consulting <br /> Sigsuature 7tz-L- -- 4-"I"`"^'"4" — Dates 2/4/2024 <br /> Address; 8727 SW 19th Ave Phone: 435-760-0717 <br /> eny,State,zip Portland, OR 97219 Fax: <br /> E-mail Address tyler©fuhrimanconsulting.com <br /> DEQ License# EH-W-10199358 CCs# <br /> Arror o MPLY.DODC Rs.Jn°,Via <br />