20200237 Ver 1_1-agent_authorization_20200214

Agent Authorization forms have been included for the areas that include potential jurisdictional WOTUS.
This includes the road right-of-way (authorization from City of Greensboro) and Parcel 0080107 owned
by Leo Terra Acquisitions LLC. The remainder of the properties listed for the permit do not contain
potential WOTUS.

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
PIN: 7873626061 PARCEL NUMBER: 80107
STREET ADDRESS: 1420 Alamance Church Road, Greensboro NC
Please print:
Property Owner: Leo Terra Acquisitions LLC
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Melissa Ruiz , Of Stantec Consulting Services Inc
(Contractor / Agent) (Name of 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):
3608 W Friendly Ave, Greensboro, NC 27410
Telephone: 3 X - Y169-365'3
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
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Auth ized Signature d
Date: ID%K O)g
Authorized Signature
Date:

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
PIN: NA right-of-way, see attached PARCEL NUMBER: M
STREET ADDRESS: see attached table, Greensboro NC
Please print:
Property Owner: City of Greensboro
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Melissa Ruiz , of Stantec Consulting Services Inc
(Contractor / Agent) (Name of 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):
City of Greensboro, PO Box 3136, Greensboro, NC 27402-3136
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Aut orized ignature Authorized Signature
Date: 1%-�>- IL" - Zolq Date: