NCC241861_FRO Submitted (2)_20240618

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book: 1920 Page: 769 County: Watauga
Parcel ID Number: 1970-60-0665-000
Street Address: 346 Dutch Creek Road, Banner Elk. North Carolina
Property Owner(please print): Ralph Earl Daughtry and Rebecca Ann Michael Daughtry
The undersigned, registered property owner(s)of the above property, do hereby authorize
JD Hamby of Restoration Systems
Grant Lewis of Axiom Environmental
to take all actions necessary for the evaluation of the property as a potential stream and wetland
mitigation project, including conducting stream and/or wetland determinations and delineations, as well
as issuance and acceptance of any required permit(s) or certification(s). I agree to allow regulatory
agencies, including the US Army Corps of Engineers, to visit the property as part of these environmental
reviews.
Property Owners(s)Address: (if different from above)
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
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Ral• Earl Da (Property Owner Authorized Signature) (D(Date)
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ebecca Ann Michael Daughtry/•roe Owner Authorized Si
P Signature) (De)
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