Agent for Owner Authorization Form

Agent for Owner
Authorization Form
When the Permit Application will be executed by a person other than the
property owner, prior to applying for the permit, the following shall be
completed and notarized by the property owner and returned to the Klamath
County Planning Department.
Authorization of Agent to Act on the Property Owner’s Behalf
I hereby authorize the following person(s) to act as my agent(s) to apply for, sign and file the
documents necessary to obtain development permits for my project.
Describe the permit and/or work to be done:
Project Location (MTL# or Address): __________________________ ___________________
Name of Authorized Agent: _____________________________________________________
Address of Authorized Agent: ___________________________________________________
Phone of Authorized Agent: _____________________________________________________
Important Disclaimer: It should be noted if there are multiple owners, purchasers or lessees of record for each
property involved in the application, each of the owners, purchasers or lessees of record will have the opportunity to
respond to the permit request. If a timely objection to the permit is received from any owner within the comment
period, the application will be deemed by the County to be withdrawn by the applicant.
___________________________________ _________________________________________
Landowner (print)
Landowner (signature)
___________________________________ _________________________________________
Landowner (print)
Landowner (signature)
State of _______________________________ )
) ss.
County of ______________________________)
This instrument was acknowledged before me this _____ day of ____________________,
20______, by ____________________________________.
Notary Public
My Commission Expires ________________________
Revised 1/2012