20221519 Ver 1_Agent Auth_20221027

5F—�I
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: LT 134 THE CAPE SEC 2A
LOT NO. PLAN NO. PARCEL I.D. R08413-002-007-000
STREET ADDRESS: 9208 Sedgley Drive
Property Owner (please print): Salt Tree Properties, LLC
The undersigned, registered property owner of the above noted property, does hereby authorize
Southern Environmental Group, Inc. (SEGi) to act on their behalf in matters regarding areas of
environmental concern.
Property Owner's Address (if different than property above):
837 Sunnyvale Road
Wilmington, NC 28412
Email: [e-mail]
Telephone:
910.470.5549
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge. f` '
Will Burnette jay`-�
Pro Owner uthorized Signature SEGi Authorized Signature
`Vrint Name
10/10/22 _
Date
David Scibetta
Print Name
Date