20231189 Ver 1_Agent Authorization Letter_20230825

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL ID: 2574077949 Deed Bk/Pg: Deed Book: 03362 Page: 0376
LOT NO.
PLAN NO.
STREET ADDRESS: 175 Thunder Swamp Rd., Mount Olive NC 28365
Owner(s) Please print: Michele Baker Ford
Owner(s) Please print: Holly Baker Harris
Owner(s) Please print: Kyle Emerson Harris (Remainderman)
Owner(s) Please print: Jenna Elizabeth Nuneviller Remainderman
Owner(s) Please print: Jordan Lemlev Ford (Remainderman)
Property Owner (signature):
Property Owner (signature):_
Property Owner (signature):
Property Owner (signature):
Property Owner (signature):
GQA-91
Tvd4 n
The undersigned, registered property owners of the above noted property, do hereby authorize
Jonathan Raeder , of _Water & Land Solutions. LLC
(Employee Name) (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):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the best of
Authorized Signature
Date:
Date: