20150463 Ver 1_More Info Received_20150603

Montalvo, Sheri A
From: TERRY KUNEFF <terry.kuneff @highpointnc.gov>
Sent: Wednesday, June 03, 2015 7:35 AM
To: Montalvo, Sheri A
Subject: RE: 4401 Peaceford Glen Dr
Attachments: Authorization Form for City of HP.pdf
Sheri,
Attached is the signed authorization form for this project.
Thanks,
TERRY KUNEFF
P.E., CFM
Ro iN
CITY OF HIGH POINT
CIVIL ENGINEER III
211 S Hamilton, Room xxx I High Point, NC 27260
336.883.8583 1 m: 336.601.3785 fax: [phone]
terry.kuneff @highpointnc.gov 1 www.highpointnc.gov
Follow Us —
Please be aware that e-mail and attachments sent to and from this address are subject to the North Carolina
Public Records Law and may be disclosed to third parties.

From: Montalvo, Sheri A [ mailto :sheri.montalvoCabncdenr.4ov]
Sent: Monday, June 01, 2015 3:45 PM
To: TERRY KUNEFF
Subject: FW: 4401 Peaceford Glen Dr
Importance: High
Good afternoon,
I am following up on this as I have not received the agent authorization for this project so that I can take it off hold and
proceed with the review process. Do you have the form that you can email to me?
Thanks
Sheri
From: Montalvo, Sheri A
Sent: Monday, May 11, 2015 10:57 AM
To: terry.kuneff @highpointnc.gov
Subject: 4401 Peaceford Glen Dr
Importance: High
Good morning,
We have received the PCN for the above referenced project. With terry's name signed on the signature page we will
require a completed agent authorization for the signature. I have attached the form for your use. You can email the
completed for back to me at sheri.montalvo @ncdenr.gov. This project will be placed on hold until receipt of this form.
Thank you,
Sheri Montalvo
401 & Buffer Permitting Unit
NCDENR- Division of Water Resources
1617 Mail Service Center, Raleigh, NC 27699 -1617
Phone: [phone]
Email: [e-mail]
E -mail correspondence to and from this address may be subject to public records laws and may be disclosed to third
parties.
Email correspondence to and from this sender is subject to the N C Public Records Law and may be disclosed to third parties

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. PLAN NO. PARCEL ID: Plat Book 139 -41
STREET ADDRESS: 4401 Peaceford Meadows, High Point, NC
Please print:
Property owner: Peaceford Meadows Homeowners Association, Inc.
Property Owner: Lambeth Management & Realty Inc.
The undersigned, registered property owners of the above noted property, do hereby authorize
Tens Kuneff, P.E. of City of High Point
(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):
4196 Mendenhall Oaks Parkway, High Point, NC 27265
Telephone:
336- 687 -0262
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Auth riz Si re Authorized Signature
Date: 4, - .7- * I J. 7 Date: