20231189 Ver 1_Agent Authorization Letter_20230825 (2)

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL ID: 2574392389 2574285334 2574272835, 2574ISM7
LOT NO.
PLAN NO.
Deed WPg:
STREET ADDRESS: Thunder Swamp Rd., Mount Olive, NC 28365
Owner(s) Please print: Edith S. Smith
Property Owner (signature):
Property Owner
The undersigned, registered property owners of the above noted property, do hereby authorize
Jonathan Raeder of
(Employee Name)
Water & Land Solutions
(MIH Company Name)
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):
804 N. Church Street, Mount Olive NC 28365
Telephone:
919-580-6918
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge.
Authorized Signature
Date: