Ver _Agent Authorization-signed_20240126 (2)

AGENT AUTHORIZATION FORM
All Blanks To Be Filled In By The Current Landowner
Name: Bhaskar Pusulari
Address: 2324 Rockland Cir, High Point, NC 27265
Phone: [phone] Email: [e-mail]
Date: 11-9-23 Project Name/Description: 216 & 220 N Dixon Ave
NCDENR — DWR USACE-Raleigh
Attn: Field Agent Attn: Field Agent
2321 Crabtree Blvd. 3331 Heritage Trade Dr. Ste. 105
Raleigh, NC 27604 Wake Forest, NC 27587
Attn: Field Agent
Field Office:
Re: Stream/Wetlands Related Consulting and Permitting
To Whom It May Concern:
I, the current Property owner, hereby designate and authorize Soil Services, PLLC to act in my behalf as
my agent in the processing of permit applications, to furnish upon request supplemental information in
support of applications, etc. from this day forward. The 3 day of November, 2023
This notification supersedes any previous correspondence concerning the agent for this project.
NOTICE: This authorization, for liability and professional courtesy reasons, is valid only for government
officials to enter the property when accompanied by Soil Services staff. You should call Soil Services to
arrange a site meeting prior to visiting the site.
Bhaskar Pusuluri
Print Property Owner's Name
cc: Field Agent
NCDENR — DWR
2321 Crabtree Boulevard
Raleigh, NC 27604
cc: Field Agent
USACE-Raleigh
3331 Heritage Trade Dr. Ste. 105
Wake Forest, NC 27587
E� 6B)<Ov
Prop y Owner's Signature
cc: Mrs. Sarah I Menser
Soil Services, PLLC
PO Box 91115
Raleigh, NC 27675
Phone: [phone] www.SoilServices.us Fax: [phone]