HomeMy WebLinkAbout20180851 Ver 1_Agent Authorization_20180617AGENT AUTHOR ATION FORM
All Bleink to Be Filled in B or Legal Repress,ntative
Address: aA (n
Phone:
Email:
Project NamODescription:
Sage Project # 2017-24
Date:
The Departmentof the Army
U.S. Army Corps of Engineers, Wilmington District
P.O. Box 1894
Wilmington, NC 28442
Attn: -
Field Office:
Re: Wetlands and Streams Related Consulting and Permitting
To Whom It May Concern:
1, the undersigned, a duly authorized owner of record of the propertylproperties identified
herein, do authorize repr+esentativos of the U.S. Array 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 Art andior Section 10 of the Rivers and Harbors Act of 1899. 1 also hereby
designate and authorize Sage Ecological Services 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 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 Sage staff. You should call
Sege to arrange a meeting prior to visiting the site.
�s
Dy:•� 7 7 'moi : [" � �� BY: "G
Print Name of Landowner or Signature of Landowner or Legal
Legal Representative Representative
AGENT AUTHORIZATION FORM
All Blanks to Be Filled in By the Current Landowner or Legal Representative
Name: \NqVak– Zzn,.y
Address: A R 3 a <sctzr, Leve 1 Ca -,U rs_k S
CC,,rn NC A') S,-) 0�
Phone: _ °i l q) A t o1 ` CIL yrl
Email: Z0
Project Name/Description:
Sage Project # 2017.24
Date: S i n
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
P.O. Box 1890
Wilmington, NC 28402
Attn:
Field Office:
Re: Wetlands and Streams Related Consulting and Permitting
To Whom It May Concern:
I, the undersigned, a duly authorized owner of record of the property/properties identified
herein, do authorize representatives of the 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. 1 also hereby
designate and authorize Sage Ecological Services 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 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 Sage staff. You should call
Sage to arrange a meeting prior to visiting the site.
BY: /I'`a f/� YS BY -/—/e �e
Prin Name of Landowner or Signature of Landowner or Legal
Legal Representative Representative