20220101 Ver 1_Agent Authorization_20220119

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 12 PLAN NO;
STREET ADDRESS:
16732 Lake Shore Drive
Cornelius, NC 28031
Please print:
Property Owner: Joseph Cantello
Property Owner:
PARCEL ID: 00103212
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(Contractor/Agent)
of Lancaster Custom Dock and Lift Systems, Inc.
(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 Owners Address (if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best of our knowledge.
Aur-22'
d Signatur
1-
Date
Authorized Signature
Hate