20190225 Ver 3_3_Middle Creek_AGENT_AUTHORIZATION_FORM_20230808

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION: 0750129771,0750139122
LOT NO. PLAN NO. PARCEL ID: 0750230303,0750221956,0750146262
STREET ADDRESS: off the north side of Sunset Lake Road, between Stonecreek Dr
and Black Forest Dr/River Falls Dr at the pump station
Please print: Town of Apex, North Carolina
Property Owner:
Property Owner:
Contact: Angela Reincke, Parks and Greenways Planner
The undersigned, registered property owners of the above noted property, do hereby authorize
James Mason, PWS
(Contractor / Agent)
of 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):
73 Hunter St, PO Box 250, Apex, NC 27502
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
James
Mason
Authorized Signature sa�.r Authorized Signature
Date: 2-2:3--7 It Date: 2/21 /2021
Three Oaks Engineering, Inc.