20201248 Ver 1_Agent Authorization Form_20210113

Environmental Consultants,
8412 FaUs of Neuse Road, Suite 104, Raleigh, NC: 2761 • Phone: [phone]W • Fax: [phone]
ssutdcc.cotn
AGENT AUTHORIZATION
Project Name/Description: Hollybrook Road Site S&EC Project # 13596
Date:
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
69 Darlington Avenue
Wilmington, NC 28403
Attn: Samantha Dailey Field Office: Raleigh Regulatory Field Office
I, the undersigned, authorizes S&EC, as my agent, to act on my behalf and take all actions necessary for
the processing, issuance and acceptance of a permit or certification and any and all associated standard
and special conditions. This notification supersedes any previous correspondence concerning the agent for
this project.
PARCEL INFORMATION:
Parcel Index Number(s) (PIN):1783949191, 1793034587, 1793151012, 1783923310,
0 178300-91-1162 (Johnston County)
Site Address: 1201 S Hollybrook Road
City, County, State: Wendell, Wake, NC
APPLICANT INFORMATION:
Name: Smith -Edwards. LLC-Fred Smith. Member
Mailing Address: 2505 Wendell Road, Wendell, NC 27591
Telephone Number: [phone]
Email: fjsjgfredsmithcompany.com
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Applicant (please print) :�,e Date
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We hereby certify the above information sub fitted in this application is true and accurate to
the best of our knowledge, /