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I, gera/L-L.- /" ca 61/4 reb authorize 4‘1E' �c , r <br /> (landowner) (applicant) <br /> to act as my agent for the purpose of submittin an erosion control and/or stormwater <br /> 200,1■ ot,,-, a c Apvelamd 2,,u<<^G S417,4.4.' ti <br /> fro Dc Cat - , h�'P <br /> management application to the Dane County Land & Water Resources Department for <br /> X;f'T- /1414 A I y riAt,i Ar«(e,'I Ce 21 g7 . Co 1(a Ja {mac,( A f Ph' <br /> (project name) 5-i)v.45 <br /> / <br /> e07/ i 0/ _ )6 <br /> .l� ..... G • 1 <br /> g *re of Own-'far IV Date <br /> ILterav\ MOAV3&�«l <br /> Name printed <br /> STATE OF WISCONSIN, County of Dane <br /> Subscribed and sworn to before me on I/ (Fl <br /> by the above named person. (date) <br /> Signature of Notary ,y, jteLf, <br /> Print or type name 5 l i -� K dY SC t c� <br /> Date commission expires It/3d( JO L F <br /> Seal: <br /> O�PRY PUe`Nlfy. <br /> y JOHN <br /> % KIRSCHNER <br />