20190299 Ver 1_agent authorization form_20190306

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. NA
PLAN NO. NA
PARCEL N0.
Project Name: Richardson Road Extension (from Humie Olive Rd to Old US 1)
Project Applicant: Town of Apex, Attn. Drew Havens, PO Box 250, 73 Hunter Street, Apex, NC 27502
The undersigned, project proponent and applicant of the above project, do hereby authorize
�eff Harbour , of
(Contractor / Agent)
Environmental Services, Inc
(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.
Applicants Address (if different than property above):
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We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge. _
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Authorized Signature
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Date. �✓�2� � .�
Authorized Signature
Date: