20230767 Ver 1_CLT17_Agent_Authorization_20230526

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 363707699340,
363819608696, 36708992517, 363711569552, 363707678981
STREET ADDRESS:
Springdale Drive, Maiden NC 28650
1250 Old Maiden Rd, Maiden NC 28650
Please print:
Property Owner: Microsoft Corporation, Chris Sander
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Melissa Ruiz , of Stantec
(Contractor/ Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance
of this delineation, permit or certification and any and all standard and special conditions
attached.
Property Owner's Address (if different than property above):
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: Jan 10,2023 Date:

CLT17 Property Access Form for ACOE
Wetlands JD
Final Audit Report 2023-01-10
Created: 2023-01-04
By: Lexi Jones([e-mail])
Status: Signed
Transaction ID: CBJCHBCAABAAPibNtOTFam_uHg4E163GGVA5B3YFT446
"CLT17 Property Access Form for ACOE Wetlands JD" History
Document created by Lexi Jones ([e-mail])
2023-01-04-6:49:14 PM GMT
C'-► Document emailed to Chris Sander([e-mail])for signature
2023-01-04-6:51:24 PM GMT
GS© Document e-signed by Chris Sander([e-mail])
Signature Date:2023-01-10-4:12:44 PM GMT-Time Source:server
Agreement completed.
2023-01-10-4:12:44 PM GMT
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