20240557 Ver 1_ECPCAA Signed Agent Authorization_20240415

AUTHORIZATION TO ACT AS REPRESENTATIVE FORM
Property Legal Description:
DEED BOOK: 1453 PAGE NO: 217
PIN NO.: 8932335218
PROPERTY STREET ADRESS: 1028 Consolidated Road, Elizabeth City, Nc 27909.
Please Print:
Property Owner: Elizabeth City-Pasquotank County Airport Authority
Property Owner: Elizabeth City-Pasquotank County Airport Authority
The undersigned property owners of the above noted property, so hereby authorize
Doug Dorman of Atlantic Environmental Consultants, LLC to,
(Contractor/Agent) (Name of consulting firm)
1. Act on my behalf and take all actions necessary for the processing, issuance and
acceptance of permits and/or certifications and any all standard and special
conditions attached.
2. Enter the property to obtain site information including inspections with regulatory
agencies (Dare County, North Carolina Department of Environmental Quality,
U.S. Army Corps of Engineers, etc.) for the purpose of obtaining permits and/or
certifications.
Property Owners Address (if different than property above):
Property Owners Telephone Number: 252-335-5634
Email Address: [e-mail]
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
S� Airport Director
Authorized Signature and Title
Authorized Signature and Title
Date: 3/23/2024 Date: