20080760 Ver 3_Property Access Certification - Executed_05-16-23_20230530

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION'°4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers(Corps)to enter upon the property herein described for the purpose of conducting on-
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. 1,the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
VIQVLS
Print Name
Capacity: Z✓ Owner ❑Authorized Agents
4�//
Date
Si ure
E. REASON FOR JD REQUEST: (Check as many as applicable)
I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
[; I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps,and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
1 intend to construct/develop a project or perform activities on this parcel which may
require authorization from the Corps;this request is accompanied by my permit application
and the JD is to be used in the permitting process.
1 intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
A Corps JD is required in order obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
I believe that the site may be comprised entirely of dry land.
Other:
3 For NCDOT requests following the current NCDOT/USACE protocols,skip to Part E.
a If there are multiple parcels owned by different parties,please provide the following for each additional parcel on a
continuation sheet.
s Must provide agent authorization form/letter signed by owner(s).
Version:May 2017 Page 3