20230997 Ver 1_Buffer auth agent auth, 604 E Geer SIGNED 7-8-23_20230714

DocuSign Envelope ID: BA92C401-8FF9-4D69-A781-083935D14AE3
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 3, block 15 PLAN NO.
PARCEL ID: 110933
STREET ADDRESS: 604 E Geer St, Durham, NC 27701
Please print: Joseph Payton Allen, III
Property Owner:
Property Owner:
Kathryn Lucille McKeen
The undersigned, registered property owners of the above noted property, do hereby authorize
of NC DENR for Buffer Authorization
(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):
606 E Geer St, Durham, NC 27701
Telephone: [phone]
we have signed this authorization for the request made by Abiel LLC.
Abiel LLc admin contact info is below:
Jenny Sizelove, [e-mail], 919-438-0910
Abiel LLC general contractor info is below:
Gene Mack, [e-mail], 770-769-7234
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
DocuSigned by:
J&'4
Authorized Signature
7/7/2023
Date:
DocuSigned by:
E� 1PdtB9EB5do4B_.
Authorized Signature
7/8/2023
Date: