20230867 Ver 1_Agent Authorization Letter_20230715

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
Deed Book/Page 3686/0112
STREET ADDRESS:
PARCEL PIN: 969615777000000
297 Church Rd. Fairview NC, 29730
Please print:
Property Owner: Suzy T Rankin
Property Owner: Edward L Rankin
The undersigned, registered property owners of the above noted property, do hereby authorize
Michael D Knoerr
(Contractor / Agent)
of Conservation Managen
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and
this permit or certification and any and all standard and special conditions attached
Property Owner's Address (if different than property above):
Telephone: [phone]
nia Tech
of
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date:
Au horized ature
Date: