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i, 7;MM EUc�)1N-er , hereby authorize pe kr 6/4141e, <br /> (landowner) t) <br /> (applicant) <br /> to act as my agent for the purpose of submitting an erosion control and/or stormwater <br /> ■ <br /> management application to the Dane County Land &Water Resources Department for <br /> z U l�r nk,'e /p $i{ /VR71/ie-6t.,2._. . <br /> (project name) <br /> K.--Z- Ce9 — 7-1'1 i }— �3" 15 <br /> 14 , �74 / a 3 / l S <br /> Signature of Owner Date <br /> IS cc -cc \\- �c_.,- N v-cx- <br /> 1 1-4 . ' . \,.:,.P\--- <br /> Name printed <br /> I <br /> STATE OF WISCONSIN,County of Dane i <br /> Subscribed and sworn to before me on 7/2 3//5 <br /> by the above named person. / (date) / <br /> Signature of Notary ,.�J�--__ 'Z.. -! <br /> Print or type name 1-,c3 v,.c..-PA t. it 1/av■ S <br /> Date commission expires (//Z S /Z011 <br /> Seel: <br /> I <br /> jPGpU E L/�c�`., <br /> NO7> Ti--.z <br /> � "' <br /> - -7 ' �'CIC <br /> w1SC <br /> 1 <br /> i <br />