Intersection Improvements at US 70 (South Church Street) and SR 1311 (University Drive), including widening South Church Street from West of University Dr. to Westbrook Ave (SR 1309) - U-6010__AGENT_AUTHORIZATION_FORM_REV_Signed

NCDOT Project No. U-6010, Alamance Co.
Intersection Improvements at US 70 (South Church Street) and SR 1311
(University Drive), including widening South Church Street to a multi -lane
roadway from west of University Drive to SR 1309 (Westbrook Avenue)
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
N/A; Within
PARCEL ID: N C DOT ROW
STREET ADDRESS: Intersection of US 70 (South Church Street) and SR 1311 (University Drive);
South Church Street from west of University Drive to SR 1309 (Westbrook Avenue)
Please print: NCDOT Highway Division 7
Property Owner:
Property Owner: ATTN : Jerry Parker
The undersigned, registered property owners of the above noted property, do hereby authorize
James Mason/Nancy Scott of
(Contractor / Agent)
Three Oaks Engineering, 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 Owner's Address (if different than property above):
NCDOT Highway Division 7, PO Box 14996, Greensboro, INC 27415-4996
Telephone:
[phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Digitally signed by Jan
Jerry Parker D.t.
Date: 2020.06.10
15:00:37-04'00'
Authorized Signature
Date: 6-10-2020
James
Mason Three Oaks Engineering, Inc.
Authorized Signature
Date: 4/27/2020
Nancy
Scott Three Oaks Engineering, Inc.
4/27/2020