20181662 Ver 1_AGENT_AUTHORIZATION_20190213

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
STREET ADDRESS:
Asheville,
61 Blalock Avenue
NC 28803
PARCEL ID: 9658-20-1811
Please print:
JD Land Holding, LLC
Property Owner:
The undersigned, registered property owner of the above noted property, does hereby authorize
William "Owen" Carson of Equinox Environmental
(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):
1701 16th Street NW, Apt. 507 Washington, D.0 20009
Telephone:
[phone]
I hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
LUJW�VW� i f--4V-L�
Aut�d Signature
-
Date: 4/30/2018

Docu5�".
6 S E C U R E 6
Certificate Of Completion
Envelope Id: 0753BE3E8C8349F6A17DDA9751604837
Status: Completed
Subject: OakleySprings_AGENT_AUTHORIZATION.PDF
Source Envelope:
Document Pages: 1
Signatures: 1
Envelope Originator:
Certificate Pages: 1
Initials: 0
Jonathan Dworin
AutoNav: Enabled
[e-mail]
Envelopeld Stamping: Disabled
IP Address: 162.248.186.11
Time Zone: (UTC -08:00) Pacific Time (US & Canada)
Record Tracking
Status: Original
Holder: Jonathan Dworin
Location: DocuSign
4/30/2018 11:28:48 AM
[e-mail]
Signer Events
Signature
Timestamp
Jonathan Dworin
�}
Sent: 4/30/2018 11:28:48 AM
[e-mail]
'� f w6viv'
Viewed: 4/30/2018 11:28:59 AM
Security Level: Email, Account Authentication
Signed: 4/30/2018 11:29:44 AM
(None)
Freeform Signing
Using IP Address: 96.235.194.233
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
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4/30/2018 11:28:48 AM
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4/30/2018 11:28:59 AM
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4/30/2018 11:29:44 AM
Completed
Security Checked
4/30/2018 11:29:44 AM
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