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ATTACHMENT (A) (Please attach to Class V Permit Application if needed) Class V Permit Application Additional Signatures Page Project Name: Additional Signatures for: ❑ Applicant ❑ Owner A. IF THE APPLICANT/OWNER IS AN INDIVIDUAL Signature of Applicant/Owner Print Name of Applicant/Owner Date Signature of Applicant/Owner Print Name of Applicant/Owner Date B. and C. IF THE APPLICANT/OWNER IS OTHER THAN AN INDIVIDUAL OR NATURAL PERSON (Examples: Corporation, Partnership, Trust, LLC, LLP, etc.) Under the penalty of perjury, I certify that I have the authority to sign this application on behalf of the Applicant/Owner, to bind the Applicant/Owner, and if so required to authorize the issuance of a bond on behalf of the Applicant/Owner. (If asked, you must provide proof of such authority to the Department). Please Note: If additional signatures are required, pursuant to your governing document, operating agreements, or other applicable agreements or laws, you must attach additional copies of this page. Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Signature Print Name Title Date Class V Permit Application Form Attachment A page 4 of 7 (Rev 10/24)