20201968 Ver 1_Agent Authorization_20210929

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. N/A PLAN NO. N/A PARCEL ID: 1617219
STREET ADDRESS: 0 US 221A HWY
Property Owner: Rutherford County (Representative: Steve Garrison, County Manager)
The undersigned, registered property owners of the above noted property, do hereby authorize
Adam Williams , of _Brushy Fork Environmental Consulting, Inc.
(Contractor/Agent) (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):
289 N. Main Street, Rutherford, NC 28139
Telephone
We hereby certify the above information submitted in this application is true and accurate to
the4,est of o knowledge.
Authorized Signature:
Date: 9/27/2021