20170207 Ver 1_More Info Received - Email_20170220

Montalvo, Sheri A
From: Montalvo, Sheri A
Sent: Monday, February 20, 2017 1:11 PM
To: [e-mail]
Subject: Bryson City Assisted Living
Attachments: Agent Authorization Form.pdf
Importance: High
Mr Sugg,
We received the PCN for the above. The application is signed by you so we will need
an agent authorization form to be completed. I have attached one for your use. You
can email it to me once completed to sheri.montalvo(a)-ncdenr.gov and I can take the
project off hold and forward it through the review process.
Thanks
Sheri Montalvo
Administrative Assistant
401 & Buffer Permitting Branch
Division of Water Resources
North Carolina Department of Environmental Quality
919-807-6303 (office)
919 807-6494 (fax)
sheri.montalvo(u-),ncdenr.gov
Physical: 512 N. Salisbury St., Ste 942-D, Raleigh, NC 27604
Mailing: 1617 Mail Service Center, Raleigh, NC 27699-1617
Nothing Compares
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North Carolina Public Records Law and may be disclosed to third parties.
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SAMPLE AGENT AUTHORI7_ATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
PARCEL ID: 6673.1.0-46-0134
STREET ADDRESS: 314 Hughes Branch, Biyson City, NC 28713
Please print:
Properly Owner: Bryson City Property Holdings LLC
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Warren Sugg, P.E. , of Civil Design Concepts, PA
(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):
P.O. BOX 2568 Hickory, NC 28603
Telephone: [phone]
We hereby certify the above information submitted in this application Is true and accurate to the
best of our knowledge.
Authoriz Signat e
Date:° /7
Authorized Signature
Date: