20200922 Ver 1_Agent Authorization_20200527

US Owny Corps,
of Engineers
' AGENT AUTHORIZATION
Property Address: 11571 NC-12, Rodanthe, NC 27968
Parcel PIN: 074200340875
Please print:
Property Owner: United. States Government, Dept. of the Interior. Fish & Wildlife Service
Property Owner: Cape Hatteras Electric Cooperative (Transmission Easement)
The undersigned, registered property owners of the above noted property, do hereby authorize
Booth & Associates, LLC — 5811 Glenwood Ave., Raleigh, NC 27612 (Agent / Consulting Firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
47109 Lightplant Road, Buxton, NC 27920
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the best of
our knowledge.
Authorized Signature
Authorized Signature
Date: 2 }�
Date:
Booth & Associates, LLC
Consulting Engineers
5811 Glenwood Avenue, Suite 109
Raleigh, North Carolina 27612
Firm License No.: F-0221
19-9212-9005 X ►1(1
0 December2019 „lx