20200824 Ver 1_Agent Auth Form Fay DOT_20200625

Piedmont Natural Gas - Agent Authorization Forrn
PROPERTY LEGAL DESCRIPTION: Fayetteville DOT Outer Loop Proiect
LOT NO.PLAN NO.PARCEL ID:
STREET ADDRESS: Multiple Parcels near_Grimes Road
Fayeteville, NC (Cumberland County)
Please print:
Propefi Owner: Piedmont Natural Gas (holder of easement)
Property Owner: Dave Vena (Proiect Manaoer at Piedmont Natural Gas)
The undersigned, registered propefi owners ofthe above noted properly, do hereby authorlze
Sara Kent , of Burns & McDonnell
(Contractor I 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 Ownert Address (if different than property above):
P.Q. Bpx 3-3068, Ch.arlotte. NC 28233-
Telephone: [phone]_ _
We hereby certitr/ the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Sisnature 0-d1YIU^
D"", DA{6 (gNA
Authorized Sionature
II t- s-'/+4 Ts\
Sara Kent, Burns & McDo.nnell_
Date: _June 15, 2020_o(e-t5- ?A?D