20220378 Ver 1_Mike - AGENT AUTHORIZATION FORM_20220310

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. N/A PLAN NO. N/A _ PARCEL ID. 169900-32-8644
STREET ADDRESS: 4880 NC Highway 42 E
Clayton, NC 27527
Please print: Flowers Crossroads Lake, LLC
Property Owner: _
Property Owner: Rebecca D. Flowers
The undersigned, registered property owners of the above noted property, do hereby authorize
J. Michael Stocks of Stocks Engineering, PA
(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):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Author ed Signa ure Authorized Signature
Date: a ot g V [6104X-3--- Date: