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MARION COUNTY PUBLIC WORKS <br /> ��I " _ BUILDING INSPECTION DIVISION <br /> ����.�— 5155 Silverton Rd NE Salem OR 97305NM RECEIVED <br /> (503) 588-5147 Fax(503) 588-7948 <br /> http://www.co.marion.or.us/PWBuildinglnspection AUG 16 2024 <br /> NOTICE AUTHORIZING REPRESENTATIVE <br /> I, Amber Marie Johnson Hathaway ,have authorized <br /> (Property Owner/Print Name) <br /> Tyler Fuhriman 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 /> 5133 & 5173 Center St NE <br /> Property Situs or Street Address <br /> And described in the records of MARION County as: <br /> Legal Description 072W29AB01500 /072W29AB01300 Tax Lot#(s) <br /> PROPERTY OWNER: <br /> Printed Name: Amber Marie Johnson Hathaway <br /> Signature: ,4irfbei-Joh ion h`atitaway Date: 07/17/2024 <br /> A...L..J.J.._...7 i.11.......,:J.117,tee 1 L.L"F3T <br /> Address: 5173 Center Street NE Phone:503-510-0058 <br /> City, State,Zip Salem, Oregon 97317 Fax: <br /> E-mail Address Amber.Johnson@movement.com <br /> AUTHORIZED REPRESENTATIVE: <br /> Printed Name: Tyler Fuhriman <br /> Company Name: Fuhriman Septic Design & Consulting <br /> Signature:+ .r.&-i-- Date: 7/11/2024 <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\3-07 Auth to Apply.doc <br /> MCS-07 Rev 03/10 <br /> SEPTIC 4 <br />