20230838 Ver 1_Agent Authorization_20230613

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 32530, 106506, 106505, &
02446
STREET ADDRESS: 8394 Ranger Island Marina Road Denver, NC 28037
Please print:
Property Owner: Ranger Island Associates, LLC
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
3ames W. Heller , of Carolina Land Solutions, PLLC
(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):
18825 W. Catawba Ave. Ste 250 Cornelius NC 28031
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
David W. Dupree, Manager
for Ranger Island Associates, LLC
S
Authorized Signature Authorized Signature
Date: 1 S r�3 Date: