20190752 Ver 3_Agent Authorization_20200603

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO, PLAN NO. PARCEL ID: 18528
STREET ADDRESS: The Chemours Company, 22828 NC 87 Hwy. W, Fayetteville, North Carolina
Please print:
Property Owner: The Chemours Company
The undersigned, registered property owners of the above noted property, do hereby authorize
Luke F. Eggering, PWS , of Parsons
(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 Address (if different than property above):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: