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<br />JUN-09-2004 07:58 FROM:PALM HARBOR VILLAGE 813-707-8984 <br /> <br />TO: 6627183 <br /> <br />P.("J1/002 <br /> <br />J <br />HOME OWNER J <br />AUTHORIZATION FORM <br /> <br />X A. <br /> <br />. <br /> <br />B. <br /> <br />PERMITS <br />SURVEY <br /> <br />A. I, --.kQ1IJ6""'t1l G::GJc;:l..4W~ ..:J'f) _. do hereby <br />authorize /}/UPr,JA. I1Lh,^,~o . to sign on <br />my behalf in Z.E.)>fIVi2/1/ds /A.vt'J county/city to pull <br />all building permits" and/or any special use type <br />permits. This includes septic permits and the set up <br />of any utility account and payment of utility taps. <br /> <br />B. I, ~E"\J~ r:;-. B1GiA.~b ~, do hereby <br />authorize Palm Harbor Village to order a survey for <br />my property. <br /> <br />Home Owners Signature: ()(' d0~ Ir <br /> <br />Date: 3f:J-'1fd f:- <br /> <br />~~~~- <br />Notary Public, State of Florida <br />( )Is ( ) Is not personally known to m.e <br /> <br /> <br />lol9 It. ,(LS1ON <br />Mt CortI'" r.. ~1181ft5 <br />~.DD0181&1 . <br /> <br />- <br /> <br />Identified. by: <br /> <br />RIlY 9122103 SMUtS r <br />