20170790 Ver 1_Agent Authorization Letter_20170612

Burdette, Jennifer a
From: Anna Reusche <[e-mail]>
Sent: Monday, June 12, 2017 5:08 PM
To: Burdette, Jennifer a
Subject: RE: Project Meetings
Attachments: D_Montgomery_High_School_Agent_Authorization_Owner_Certification.pdf
Hi Jennifer,
I don't have one for the Mist Lake Site yet. But here is the one for Montgomery County High School
which we are meeting at on-site Wednesday.
Thank you,
Anna Reusche, PWS
Environmental Project Manager
www.timmons.com
5410 Trinity , Suite 1021 Raleigh, NC 27607
Office: 919.866.4500 I ax: 919.859.5663 I ite: 919-816-774
anna.reusche(aD-timmons.com
Your Vision Achieved Throughurs
To send me files greater than 20MB click here.
From: Burdette, Jennifer a[mailto:[e-mail]]
Sent: Thursday, June 08, 2017 9:12 AM
To: Anna Reusche <[e-mail]>
Subject: Project Meetings
Anna,
Would you please send me agent authorization forms or applicant contact information for Montgomery and
Mist Lake so that I can register them in our system?
Thanks,
Jennifer
Jennifer Burdette
401/Buffer Coordinator
Division of Water Resources - 401 & Buffer Permitting Branch
Department of Environmental Quality
919 807 6364 office
iennifer.burdetteQncdenr.gov
1617 Mail Service Center
Raleigh, NC 27699-1617
(Physical Address: 512 N. Salisbury St, Raleigh, NC 27604 - 9t" Flr Archdale Bldg — Room 942F)
Email corretil'.)ol?"'{,ence to and ii`orn thio; a('{"'{I`ess o; sut yect to t1he
P,Iodhl Carolina Public Records L w and 1`Y7ay be ftl`ii:'losed to tr'loird I'.'s'ai{`ies,

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TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
AGENT AUTHORIZATION and
PROPERTY OWNER CERTIFICATION FORM
All Blanks to be Filled in by Current Landowner
The Department of the Army NCDENR — Division of Water Resources
US Army Corps of Engineers 401 & Buffer Permitting Unit
Wilmington District 1650 Mail Service Center
PO Box 1890 Raleigh, NC 27699-1650
Wilmington, NC 28402-1890
To Whom It May Concern:
I, the undersigned, current property owner designate and authorize representatives of Timmons Group,
Inc., to act on 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.
This the 28 day of February -20 17 .
(number) (Month) (Year)
I, the undersigned, a duly authorized owner of record of the property/properties identified herein, do
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 and issuing a
determination associated with Waters of the U.S. subject to Federal jurisdiction under Section 404 of the
Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899.
This notification supersedes any previous correspondence concerning the agent for this project.
/
Project Name: �r { �t q e, k ScLocation:
Property Owner's
Property Owner's
Property Owner's Mailing
Property Owner's Telephone: 1 S ��' ` S / Fax No. O f
Property Owner's Email Address: & . K-13,
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