20220006 Ver 2_SignedAgentAuthorization_20220127

AGENT AUTHORIZATION FORM
The undersigned, registered property easement owners (see attached property documentation),
do hereby authorize
Dan Zudo of WK Dickson
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature glv\ n,,.ut L,,.n
Date: �1. Ona: I
Authorized Signature
Date: