20231696 Ver 1_Site Plan_20231213

f.4
C;)
(D
EPA
AA
4ij
LU
;16
r4 --1
cc

uoTllou8dM9 xo :l M MO '9NIi133NIJN3 SIXV ON 3H01 3AV1 "N0 31101VHO 69Z G 1(30 ZS
f62bf 9960-f[5-828 Ntlld /l -oH .33r
vbSalt laSalidAB Ib ANi S0 2fS[ 971N3n Ili 'DNlVYV =l Nooa NOISN31X3 �IOOO M3N fz z� ee
01 103f08d
0
O
� O
w Jz
Q
O
zr
z�m
z
o z
zm� �
�QwQ I LL=
Yo
m Q Q O o _ U
z Qom III
mU�zI
Q II
w i
Q �II
z o m a I I
i
i
i
I
i
rl
i w
r a
li I,
1
I
I -
-
I-
-
I �
I j
j
I I
I I II
I I®II — —
-
� � O�O

uoapou8d�8ua9xo :¶tlW3 Nttd '9NIi133NIJ N3 SIKtl S]N 3nflt 3Mtlt "a0 31101atlH] 89Z nns �v No Gff dN is
9960-fIS-928 I �// off 133H
valaau 9nn9n Ilr SN011035
2t s dAB Ib ANOISN31X3 �IOOO M3N fz z e
bSlNi fl 2fS[
rz z�3L da 01 1�3f08d
b Z
m wp W
00
Ls
00
-w Z

f.4
C;)
(D
EPA
AA
4ij
LU
;16
r4 --1
cc

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0, PLAN NO.
STREET ADDRESS: 269 Charlotte Dr., Lake Lure, NC
Please print:
Property Owner: Carmen Scott
Property Owner:
PARCEL ID:
The undersigned, registered property owners of the above noted property, do hereby authorize
Beresford W. Powell, P.E. , of AXIS ENGINEERING, PLLC
(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]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature I
Date: D -1 Ia—/ 2�
Authorized Signature
Date: