20140991 Ver 1_More Info Received_20141015

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October 15, 2014
Project C121104 15
Karen Higgins
Supervisor, 401 and Buffer Permitting Unit
Division of Water Resources
512 North Salisbury St
Raleigh, NC 27604
Dear Mrs Higgins,
We are including four (4) copies of our Agent Authorization Form The Agent Authorization form included is
in response to the request for additional information GAI received on September 17, 2014 Fred Harmeling
the project manager and our Dominion Virginia Power contact signed the form on October 15, 2014 We
are transmitting the form via FedEx to arrive at your office on October 16, 2014 We will call Sheri Montalvo
at 919 - 807 -6303 on Thursday, October 17, 2014 to verify receipt
Respectfully submitted,
Geor Williams
Design Manager
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C T 1 5 2014 !
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AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
1 BLK A LILY POND SEC I PARCEL ID: 472853307500
STREET ADDRESS: 1803 Barlow Road, Tarboro, North Carolina 27886
Please print:
Easement Assignee Virginia Electric and Power Company (Book 27.5 age 484)
Property Owner- Town of Tarboro (Book 1420/Page 0003)
The undersigned, registered property owners of the above noted property, do hereby authorize
George Williams , of GAI Consultants, Inc
(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):
P.O Box 220, Tarboro, NC 27886
Telephone- (252) 641 -7855
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
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Authorized SigVaiure
Date:
Authorized Signature
Date.
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V11 OCT 1 5 2014 lU