20230553 Ver 1_Ashcroft_Agent_Auth_Form_20230417

PROPERTY LEGAL DESCRIPTIM
LOT NO. PLAN NO. PARCEL ID, 799307586585
STREET ADDRESS: Ed Wilkins Dam, located behind Ashcroft and Winterberry Drives, Reidsville, N
Please print:
Property Owner: Ashcroft Lake Association, Inc
The undersigned, registered property owners of the above noted property, do hereby authorize
Amy Black, PE, of LJB Engineering PC
(Contractor / Agent) (Name of consulting firm)
to act on the owiner's 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 cIfferent than property above) :
Ashcroft Lake Association
c/o Larry Huffman, Ashcroft Lake Assoc. President
1318 Winterberry Drive
Reidsville, NC 27320
I hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge.
Authorized Siig tore
OR