20140881 Ver 1_More Info Received_20140924

McGill
A S S O C I A T E S
AGENT AUTHORIZATION FORM
PROJECT NAME: Horton Branch Trail
PROPERTY LEGAL DESCRIPTION:
PARCEL ID. 2848 -14- 2625 -000 LEGAL DESC. T -1 1539/228 446.995A
STREET ADDRESS: = R•,.•
Boone, :.,1
Please Print (� �� � )
Property Owner /Representative: (�i . 1 ly
(If Representative) Title: fTN'�- IQ
The undersigned, registered property owners of the above noted property, do hereby authorize
John C. Vilas , of McGill Associates P.A.
(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 /Representative's Address (if different than property above):
C a - 10
RZ)X / �7 &-ov)TV64w-4 Q - <f gi�> c5-
Telephone: -- U / /
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:
Environmental 0 Planning Finance
McGill _ {ssoeiates. P.A. • :'64 Rantinger Road, Banner Elk. _A'orth Carolina, _'NO04
Office. R'8- 'y' -6Q46 • Fax