20221257 Ver 1_Pre-Filing Meeting Information_20220908

AGENT AUTHORIZATION FORM
PROPERTY DESCRIPTION:
The Winston-Salem/Forsyth County Utilities Commission (WSFCUC) proposes to install
approximately 13,000 LF of 36" sanitary sewer outfall, and approximately 3,000 LF of sanitary sewer
collectors ranging in size from 8-inches to 18-inches, in an approximately 30 to 45-foot-wide
construction corridor in the south-eastern portion of Forsyth County, North Carolina.
STREET ADDRESS: N/A — project site Is a transmission line corridor easement
PROPERTY OWNER: Multiple
The undersigned, Michael Stover, PE, Deputy Utilities Director for the Winston-Salem/ Forsyth
County Utilities Commission, do hereby authorize
Linda Diebolt o f Hazen and Sawyer
(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, excluding any
and all financial obligations.
SIGNATORIES ADDRESS:
Winston-Salem/Forsyth County Utilities
P.O. Box 2511
Winston-Salem, NC 27102
Telephone: [phone]
[e-mail]
I hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature:
Date: 7/Z (/7iv Z Z