20190027 Ver 1_AGENT_AUTHORIZATION_20190103

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
0852-03-04-3215 and
DEED BK. 7868 PAGE NO. 202 PARCEL ID: 0852-03-03-6806
STREET ADDRESS: 3131 Cheek Road and 1223 Benbow Road Durham NC 27704
Please print:
Property Owner: Jose M. Castillo Araueta
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Robert Hopper, PE , of CDM Smith Inc
(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):
616 LAKEVIEW DR RALEIGH, NC 27603
Telephone: Q I `( _25�75;__ A
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: ®2 2— �Zl Date: