20230429 Ver 1_Agent Authorization_20230323

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: 5 PLAN NO: PARCEL ID: 471001075144
STREET ADDRESS:
8283 Long Island Road
Catawba, NC 28609
Please print:
Owner: Mark Reddick
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Donna P. Hrko
(Contractor/Agent)
of Lancaster Custom Dock and Lift Systems, Inc,
(Name of consulting frm)
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 Owners Address (if different than property above):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate tothe
best bf qar kn edge.
Authorized Signature Authorized Signature
1-28-2023
Date
Date