Letter of authorization for signature



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LETTER OF AUTHORIZATION FOR SIGNATURE
APPLICATION FOR:
 Certificate of Assured Water Supply

 Assignment of a Type A Certificate of Assured Water Supply

 Assignment of a Type B Certificate of Assured Water Supply

 Classification of a Type A Certificate of Assured Water Supply

 Water Adequacy Report

 Analysis of Assured Water Supply

 Analysis of Adequate Water Supply

 Physical Availability Determination

PLEASE COMPLETE ONE FORM PER OWNER OR BUYER!
The Assured and Adequate Water Supply Rules, A.A.C. R12-15-701 et seq., allow a representative to sign an application for assured or adequate water supply on behalf of an applicant if the applicant submits a letter, signed by the applicant and dated within 90 days of the date the application is submitted, authorizing a representative to submit applications for permits regarding the land to be included in the application. This form, when completed correctly, fulfills this purpose.
The applicant listed below hereby authorizes ___________________________________,

Name of Representative

of ____________________________________________________________________, Representative’s Company, if applicable

as its representative to submit applications for permits regarding the land to be included


in the application for______________________________________________________,

Name of subdivision, master plan, or area included in the application


and to sign the application on behalf of the applicant.
________________________________________________________________________

Applicant’s printed name


_________________________________ ____________________________________

Applicant’s title Date


________________________________________________________________________

Applicant’s company name or entity name as it appears on the title report or deed



Additional copies of this page may be made as necessary.
Letter of Authorization for Signature REV 10-26-07

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