20231664 Ver 1_Agent Authorization_20231207

PROPERTY LEGAL DESCRIPTION:
LOT NO. 620 PLAN NO. PARCEL ID:
STREET ADDRESS: 5 3d.sc9 �z �t
Please print:
Property Owner:
Property Owner: -'s A le ,
The undersigned, registered property owners of the above noted property, do hereby authorize
Janice Estep of CBC Stone & Recycling LLC
(Contractor / Agent) (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):
Telephone: [phone] Steve or 704-200-4335 Sara
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Owner
Date:[1 t
Autho ed Signature Ag nt
Date: I I L3012.