20230790 Ver 1_Agent Authorization Frog Level-Signed_20230602

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS: 3925 Frog Level Rd, Greenville, NC 27834
Location of Frog Level Pump Station (start of project)
Please print: City of Greenville
Properly Owner:
Property Owner: Attn: David Springer, PE, Interim Director of Water Resources
The undersigned, registered property owners of the above noted property, do hereby authorize
Jim Mason /Nancy Oberle Of
(Contractor / Agent)
Three Oaks Engineering, Inc
(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):
PO Box 1847, Greenville, NC 27835
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
!r \
Greenville Utilities Commission
Authorized Signature '
Date: 5/25/2023
Electronically signed by: Elcctwimlysigicaby:
Authorized Signature
Date: 02/14/2023