20160423 Ver 1_Agent Authorization_20160426

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 0629-01-99-9110, 0839-01-19-9005
STRIsETADDRESS: 2306 MOORES MILL RD
ROUGEMONT, NC 27572
Please print: NEIL FRANK
Property Owner:
Property Owner:
CATHERINE FRANK
The undersigned, registered property owners of the above noted property, do hereby authorize
Joshua White
(Contractor / Agent)
Of Civil & Environmental Consultants, Inc.
(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.
Property Owner's Address (if different than property above):
Telephone:
919-491-9742
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Author ed Signature Authorized Signature
Date: -3I P g // G Date: 3 l 1(�'