20160071 Ver 2_AgentAuthorization_SamsBranch_20180515

AGENT AUTHORIZATION FORM
TOWN OF CLAYTON
Project Name: Sam's Branch Greenway
Project Location: Sam's Branch Creek Corridor from O'Neil Street to City Road
Date: January 2015
The Town of Clayton, undersigned, does hereby authorize:
The Professional Engineers and Scientists
of
(Contractor / Agent)
Ecological Engineering, LLP
(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.
Town of Clayton, NC
Mailing Address: P.O. Box 879
Clayton, NC 27520
Physical Address: 111 E. Second Street
Clayton, NC 27520
[phone], ext. 5400
I hereby certify the above information submitted in this application is true and accurate to the
best of my knowledge.
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Date