20180312 Ver 1_Agent Authorization_20180322

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. N/A PLAN NO. N/A PARCEL ID: 0873-00-39-7236, 0873-00-
49-5501; 0873-00-7503; 0873-00-38-3261; 0873-00-38-6125
STREET ADDRESS: Multiple sites off State Road 1211, Bakersville, NC 28705
Property Owner:
Resource Institute representing multiple property owners including: Robert McKinney, Clarissa
Communitv Center, Russell J. Diller, and Gertrude Smith
The undersigned, registered property owners of the above noted property, do hereby authorize
Adam Williams , of Brushy Fork Environmental Consulting, Inc.
(Contractor/Agent) (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
336.750.0522
We hereby certify the above information submitted in this application is true and accurate to
the best of our knowledge.
Authorized Signature:
Date: 03/22/2018