20191595 Ver 1_Agent Author Form-Signed_20191120

Shaping Communities Together
AGENT AUTHORIZATION FORM
PROJECT NAME: Lakeview Drive Bridae
PROPERTY LEGAL DESCRIPTION: The majority of the project is within public road right-of-way. Portions of
the project area overlap two parcels:
1) LOT 57 A 58 A SEC 1 WEST OF LOT 56 A SEC 1
2) 218 AC THAGGARDS LAKE
PARCEL ID. 1) 00030767
22) 00039942
STREET ADDRESS: 1) 128 Lakeview Drive
2) NIA
Please Print
Property Owner/Representative: Village of Whispering PinesLl3ob.lSssinge
(If Representative) Title: Public Works Director
The undersigned, registered property owners of the above noted property, do hereby authorize
Jonathan Herman & Jon Swaim, of _ McGill Associates P.A.
(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.
Property Owner's/Representative's Address (if different than property above):
10 Pine Ridge Drive
Whisoerina mines. NC 28327
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the best of our
knowledge.
Authorized Signature Authorized Signature
Date: %0 21 l Date:
1013 STATE FARM ROAD, BOONE, NORTH CAROLINA 28607 1 828.386,1920 1 www.mcgillassociates.com