20221355 Ver 1_Crab Creek Stefan Simoncic Agent Form_20220929

Jennings
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919-60D-4 17"90 [e-mail]
7 Samuel he Drive, Asheville, NC 29805 I
AGENT AUTHORIZATION FORM
Project Location: 1605 Crab Creek Rd Hendersanville NC 28739 3S.237382 -82.597869
The undersigned, registered property owner(s) of the above noted property, do hereby
authorize Jennings Environmental PLLC to act on the property owner's behalf and take al(
actions necessary for the processing, issuance, and acceptance of the permit or certification
and any and all standard and special conditions attached.
The property owner(s) hereby certify that the information submitted in this application is true
and accurate to the best of our knowledge.
Property Owner(s):
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Owners) Address: 06 1 % ' �, yr 0 a, V Vc-
Owner(s) Phone;
Owner(s) Email:
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Jennings Environmental PLLC is licensed with the North Carolina Board of Examiners for Engineers and Surveyors and is
authorized to practice engineering under the provisions of Chapter 89C and 55B of the General Statutes of North Carolina.
License Number P-1932.