20200758 Ver 1_Agent Authorization_20200610

NCDOT Project No. U-6010, Alamance Co.
Intersection Improvements at US 70 (South Church Street) and SR 1311
(University Drive), including widening South Church Street to a multi -lane
roadway from west of University Drive to SR 1309 (Westbrook Avenue)
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
N/A; Within
PARCEL ID: NCDOT ROW
STREET ADDRESS: Intersection of US 70 (South Church Street) and SR 1311 (University Drive);
South Church Street from west of University Drive to SR 1309 (Westbrook Avenue)
Please print: NCDOT, Highway Division 7
Property Owner:
Property Owner:
ATTN: (Jerry Parker
The undersigned, registered property owners of the above noted property, do hereby authorize
James Mason/Nancy Scott of Three Oaks Engineering, Inc.
(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):
NCDOT Highway Division 7, PO Box 14996, Greensboro, NC 27415-4996
Telephone:
[phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Digitally signed by Jerry James
Parker ze,sare 'w`m
Jerry Parker Date,2020.06.1° Mason °" '°'°°'' Three Oaks Engineering, Inc.
15:0037-04'00'
Authorized Signature Authorized Signature
Date: 6-10-2020 Date: 4/27/2020
Nancyo, �n
Scott Three Oaks Engineering, Inc.
4/27/2020