20151255 Ver 1_More Info Received_20151209

Montalvo, Sheri A
From: Rodney Wright <[e-mail]>
Sent: Tuesday, December 08, 2015 2:56 PM
To: Montalvo, Sheri A
Cc: 'Marvin Cavanaugh'; 'Janice Pack'
Subject: Information
Attachments: Bradley Robertson - Agent Authorization.pdf
Ms. Montalvo,
I am attaching the Agent Authorization form. Please let me know if you have any questions, Thank You, Rodney
Rodney Wright
Dan River Watershed Coordinator
Stokes Soil & Water Conservation District
PO Box 98
Danbury, NC
336.593.2846 ext. 3
336.593.9232 Fax
[e-mail]
www.stokesswcd.org
1

DEC 0 9 2015
SAMPLE AGENT AUTHORIZATION FORM L 4�1 8 BUFFER PERMITT,j
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO, PARCEL ID: Lei >c1 "- oc)
STREET ADDRESS:
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Please print: /
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
(Contractor f 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: — 59 3 -- 2�&`% (f�4 , k=
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature/"
Date: Z ���!liJP
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Authorized Signat re
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Date: I A 1 1 7.1( �;