20201479 Ver 1_Agent Authorization_20210127

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USACE/NCDWR Agent Authorization Form
Property/Site:
Address of Site:
Parcel Identification Number (PIN):
Owner Information:
Name:
Address:
Telephone Number:
E-mail Address:
Property Owner Certification:
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)
and/ or the North Carolina Division of Water Resources (NCDWR) 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 (WOTUS) subject to Federal/State jurisdiction under Section
404 and 401 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899.
Terracon, as designated by the current property owner, is the authorized consultant to coordinate,
schedule, and provide supplemental information to both agencies in support of this verification
and/or permit application.
Property Owner Signature:
Date: l42.1N- 9
-,, Terracon Consultants Inc. 2401 Brentwood Road, Suite 107, Raleigh, NC 28208-3608
P:919-873-2211 F:919-873-9555 terracon.com