20230143 Ver 1_Agent Authorization Form_20230118

AGENT AUTHORIZATION FORM
The undersigned, registered property easement owners (see attached property documentation),
do hereby authorize
Dan Zurlo of WK Dickson & Co. Inc
(Contractor 1 Agent) (Name of consulting firm)
to act on behalf of the Town of Bakersville 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 for the Bakersville ARPA Water & Sewer
Relocations project.
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:11 /17/22
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Authorized Signature
Date: I,( / 17< 2e 2Z