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DocuSign Envelope ID:29F350EB-C553-4EEB-BD97-898B3775EE03 <br /> PROPERTY OWNER(APPLIC NT) WITNESS <br /> COMPANY' ^ ��"''s`� NAME <br /> SIGNATUR SIGNATURE <br /> ADDRESS &ekll X� ZFr.PS ADDRESS f90 <br /> Phone No. (I <br /> AUTHORIZED AGENT WITNESS <br /> COMPANY CLH Desi n pa-Steve Miller NAME fipe Pfeifer <br /> SIGNATURE SIGNATURE <br /> ADDRESS 400 Regency F rest Drive STE 120 ADDRESS 400 Regency Forest Drive S <br /> Cary,NC 27518 Phone No. 9193196716 Cary,NC 27518 <br /> Y ✓ 4 -.sn R A'4 3 1 A <br /> € ,Y�, ' � a ��y� K - �,... �y � y'z.Y������� ,i e ✓ +Y , , r ,���� �. s�J,r.''� � Y�f"s y�,��'a ? ��.,r f <br /> I � � <br /> APPLICATION RECEIVED BY DISTRICT ENGINEER <br /> i <br /> i <br /> SIGNATURE DATE <br /> } <br /> r <br /> APPLICATION APPROVED BY LOCAL GOVERNMENTAL AUTHORITY(when required) <br /> 1 <br /> SIGNATURE TITLE DATE <br /> APPLICATION APPROVED BY DISTRICT ENGINEER <br /> e <br /> SIGNATURE p TE <br /> INSPECTION BY NCDOT <br /> SIGNATURE TITLE DATE <br /> i <br /> COMMENTS; <br /> i <br /> i <br /> € <br /> i <br /> 3 <br /> 3 <br /> I <br />