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MARION COUNTY PUBLIC WORKS <br /> " BUILDING INSPECTION DIVISION ''6) U <br /> 5155 Silverton Rd NE <br /> Salem OR 97305 RECEIVED <br /> (503) 588-5147 Fax(503) 588-7948 AUG 05 <br /> http://www.co.marion.or.us/PW/Buildinglnspection ZQ2 <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Kyle Gulstrom , have authorized <br /> (Property Owner/Print Name) <br /> Tyler Fuhriman to act as myagent in performingthe <br /> Y g <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 /> 22935 Jennie Rd SE I Lyons, OR 97358 <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 092E18AD01000 Tax Lot#(s) <br /> PROPERTY OWNER: <br /> Printed Name: Kyle Gulstrom I Foodology Mobile Kitchen LLC <br /> Signature:KyeGul ;Aug 2,202a1523PDT; Date: 08/02/2024 <br /> Address: 11343 Branch Ln SE Phone:503-881-9874 <br /> City, State,Zip Stayton Fax: <br /> E-mail Address foodologymkta7.gmail.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Tyler Fuhriman <br /> Company Name: Fuhriman Septic Design & Consulting <br /> Signature: c. Date: 8/2/2024 <br /> Address: 8727 SW 19th Ave Phone:435-760-0717 <br /> City, State,Zip Portland, OR 97219 Fax: <br /> E-mail Address tylerafuhrimanconsulting.com <br /> DEQ License# EH-W-10199358 CCB # <br /> G:\FORMS\SEPTIC\S-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />