20231037 Ver 1_Calvary Road Baptist Church_20230724

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M U N T A I N
SITEWORK INC.
Canton, NC
Will Norris a23-4o0-45(,o
2552 old diver Road, Caotow, NC ZF)71(
[e-mail]
Calvary Read Haptist Church
2177 Russ Avenue
Waynesville. NC 28786
Attn: John Srvanger
828-926-0506
July 170, 2023
Project: CALVARY ROAD BAPTIST CHURCH, MAGGIE VALLEY, NC
To remove material from both ends of existing culvert.
Then to pump existing stream around disturbed area.
Lower stream bed and clean out filled in culvert and re -build head -wall on
inlet end of existing culvert
NOTE: This project is contingent on permits that will be applied
for by Kevin Norris

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION.
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS: l yo! So ' z, a� Q
✓� v -ram
Please print:
Property Owner: 22 11-4 P-� A,( j�"� �S-� C- �'I JP-011
Property Owner:
The undersigned, registered property owners of theabove noted property, do hereby authorize
n
(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):
c��ie5
Telephone: _U 6- I l&- b; 0 0
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
thorized ignatlure Au horized Signa ure
Date: 1 - 2'l - Z :" Date: 2 Z