20231508 Ver 1_Site Plan_20231108

Se ptem ber 26, 20 23
0 0.015 0.0 30.007 5 mi
0 0.0 25 0.0 50.0125 km
1:1,01 7

Ow ner : NO NE MA N JA CK W & LECLE RE G Mailin g A ddr ess:220 1 OX FO RD RDRALEIGH
Parcel I D: Total Acres :0.42
Cu r ren t Value:963 63 0Location:113 L AK ESI DE PO I NT27608-16 36
Se ptem ber 26, 20 23
0 0.015 0.0 30.007 5 mi
0 0.0 25 0.0 50.0125 km
1:1,01 7

Ow ner : NO NE MA N JA CK W & LECLE RE G Mailin g A ddr ess:220 1 OX FO RD RDRALEIGH
Parcel I D: Total Acres :0.42
Cu r ren t Value:963 63 0Location:113 L AK ESI DE PO I NT27608-16 36
SAMPLE AGENT AUTHORTZAUON FORM
PROPSO Y LEGAL DE!3QnP-UON:
LOT N0. PLAN N0. __---_ PARCEL ID; ` 6 33 'Ot)
5TREETADDRF5s: l lG�- 5I-r/_ : Pca:/j,-r-
r
iv . '� ' 7 r 3 - -----
Please print
Prmpetty Owner_
Property Owner, LTQ
The undersigned, registered property owners of the above noCed properly,, do hei e y authorize
of gt�lj-
(Cant radvr J Agent) (Name of conmlbngfirm)
to act on my behalf and Cake all actions necP ryfbrihe processing issuance and acceptance of
U'js Penrjv' or cerMcats'on and any and aU standard and special concWons at acJ,ed_
PronPrty nwneYsAddress Of diff-rentthan property above):
� � �'� r �I �J c. _
Telephone: j�_aL2 - �d , . 3C9�
We hereby cartify iiie above information subhu-tted in iris application lstrue and accurate to lire
best of our knowledge.
Authorized Sly ai ue
Date: