PNG479SupplementalInfo_Appendix A

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Bright People. Right Solutions.
APPENDIX A
Agent Authorization Form

Agent Authorization
Form
Project: Piedmont Natural Gas Line 479
Property Legal Description: Multiple Properties — see enclosed maps
Street Address: Multiple Properties — see enclosed mans
Easement Holder(please print): Piedmont Natural Gas
The undersigned, registered property owners of the above noted property, do hereby authorize
Kleinfelder, Inc.
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.
Easement Holder's Address (if different than property above):
4720 Piedmont Row Drive Charlotte NC 28820
Telephone #:
Email Address:
Signature (Contactor/Agent)
Tom Digitally signed by
Tom Morris
Morris Date: 2023.01.10
14:38:13-05'00'
Print Name / Title