20120532 Ver 1_More Info Received_20120531

Dennison, Laurie
From Brad Johnson [brad Johnson @eastgroup corn]
Sent Thursday May 31 2012 12 54 PM
To Dennison Laurie
Subject Sharpsburg Park PCN Agent Authorization
Attachments 0250_0001 pdf
Please find attached an agent authorization from the Town of Sharpsburg
Thanks
C Brad Johnson PE
The East Group
brad iohnson(o)eastarour) corn
324 Evans Street
Greenville NC 27858
[phone] ext 139

SAMPLE AGENT ALrrHOR17 -A -nON FORM
PROPERTY LEGAL DESCRIPTION
LOT NO N/A - -- PLAN NO PARCEL ID ' 408 376 is aao
STREET ADDRESS let 1zt-i Po id (W-SR 140 1
Please print
Property Owner Town of Sharpsbuxg Ota,� Ray I'zxector of Publ2c Wor,cs
Piopeity Owner
1 he undersigned registered property owners of the above noted property do hereby authorize
r4iGhc11e b c i Pinc ntts ^ of the F3 t Croup
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the piocessing, 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)
110 Kai Iroad ,,greet �hnr).,3burq NJ- 2 78 t8
Telephone [phone]c14
We hereby certify the above information submitted in this application is true ar'd accurate to the
best of our knowledge
Authorized Signature
Date
Authorized Signature
Date