20221125 Ver 1_22-183_Agent Authorization_20220503_20220623

PUBLIC WORK; DEPARTMENT
STORMWATER MANAGEMENT DIVISION
405 Martin Luther King, Jr. Blvd.
Chapel Hill, NC 27514-5705
Telephone [phone]
Fax [phone]
vmw.townofchapelhill.org
Stream Determination Request
AUTHORIZED AGENT FOR LEGAL REPRESENTATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL ID (PIN) 9» 1 O ±3 5gij6
STREET ADDRESS:
Please print: N NNIe "w+? e- GAzzet C o w144",s�-t
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Pro ert ❑caner: 4',tT.,e-t��
Property Owner 17a-04, o T$roc 3 05Arivis- o r!
IClei s ri pem-vdt 4-5 54 *iv ri •�
The undersigned, owner(s) of the above described grope: ty, do hereby authorize
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6-ete , of �r,# �G OL, p6 /AL SE.€1/ E-5/ ,
(ContractorlAgent) (Name of consulting firm if applicable)
to request a stream determination on this property and to act on my/our behalf and take all actions, live could
have taken if present, necessary fcr the processing, issuance and acceptance of the stream determination for
this property.
Property Owner's Address (if different than property above):
Y 72 EewiN ,ea,Ovrg ,� , A/ Z7707
Owner Telephone: 9/ I - 4.` - 7210 Email: CAS ri4 erdei.z.omo-stipie : e.ri!
We hereby certify the above information submitted is true and accur-Az to the best of our knowledge.
er Auth
orized Authorized Signature
Owner Authorized Signature
Date
Date
Contractor/Agent Authorized Signature Date
Please return to by email (a lametif@townotchapelhilLorg). fax, or ?? a (to the above address in care Or .
"Storrnwator Analyst." The form may also be dropped off at the Storms ater Management office at
208 N. Columbia Street. Chapel !-iHi, NC. For questions, please call (919) 959-RAIN.
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Version 2/21E2017

PUBLIC WORKS DEPARTMENT
STORMWATER MANAGEMENT DIVISION
405 Martin Luther King, Jr. Blvd.
Chapel Hill, NC 27514-5705
Telephone [phone]
Fax [phone]
www.townofchapelhill.org
Stream Determination Request
AUTHORIZED AGENT FOR LEGAL REPRESENTATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL ID (PIN) _16.'1 0 7yQ 7L2
STREET ADDRESS:
Please print:
Property Owner: G&/YD *I MAC 1 e-4'Z1 L f
Property Owner: (J SOP/ Dii 12 i)/ Z5 A NP K?Iff D# /1Lc .5GAr4 A ' d
The undersigned, owner(s) of the above described property, do hereby authorize
5 4N �. .
(ContraoloriAgent)
,of _5;46 5"E'A21f/C�.S,,,G.
(Name of consulting firm if applicable)
to request a stream determination on this property and to act on my/our behalf and take all actions, I/we could
have taken if present, necessary for the processing, issuance and acceptance of the stream determination for
this property.
Property Owner's Address (if different than property above):
2
F
Owner Telephone:
tog-667 37o°
Email: P 1/ 6 lei b-e '/'/4/c . 6.0)0
We hereby certify the above information submitted is true and accurate to the best of our knowledge.
Ownelk
orized Signature Date
Owner Authorized Signature
ContractoriAgent Authorized Signature
Date
Date
Please return form by ern- l (e ieakkley@t04` li7rCi?ap iflStl.Gris?, %, C r mail to the above addr'esa in care Of the
°Sttom water Analyst,' The forrn my also be dropped 'rtt wt th S annwa er Management office at
208 N. Columbia Street, Chapel Hill, NC. For guestinns, please cal! (919) 969-RAIN.
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Version 2 2gnon

PUBLIC WORKS DEPARTMENT
STORMWATER MANAGEMENT DIVISION
405 Martin Luther King, Jr. Blvd.
Chapel Hill, NC 27514-5705
Telephone [phone]
Fax [phone]
www.townofchapelhill.org
Stream Determination Request
AUTHORIZED AGENT FOR LEGAL REPRESENTATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL ID (PIN) In ?Oe f3y 9j909q55/z., 1et#015603, .7090.5
07-r "104/41* ao op305 51' 0-7 4/0 7f
r my/v*1i 'ex:,
STREET ADDRESS:5 2z-7 mr moi2hign ,Qoocif
Please print:
Property Owner:
Property Owner:
The undersigned, owner(s) of the above described property, ci( hereby :authorize
Qv
,ofE 01.0a.14 1i‘.511
(Contractor/Agent) (Name of consulting firm if applicable)
to request a stream determination on this property and to act on my/our behalf and take all actions, 1/we could
have taken if present, necessary for the processing, issuance and acceptance of the stream determination for
this property.
Property Owner's Address (if different than property above):
....5-',19/z77A/ 7A //N/- Z7g06
Owner Telephone: 9/9- ?-1/-efily Email: (222 e C Roe cv-P2
We hereby certify the above information submitted is true and accurate to the best of our knowledge.
honze Signature
Owner Authorized Signature
Contractor/Agent Authorized Signature
Ooz
Date
Date
Date
s e return form by email (aweakley©townofchapelhillxb, fax, or mail to the above address in care of the
"Stormwater Analyst" The form may also be dropped off at the Stormwater Management office at
208 N. Columbia Street, Chapel NC. For questions, please call (919) 969-RAIN.
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Version 2/21/2017

Name:
Address:
Phone:
Email:
ECOLOGICAL
SERVICES
AGENT AUTHORIZATION FORM
All Blanks to Be Filled in By the Current Landowner or Legal Representative
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/1/49/4z &-‘444 276o
VI- 77/ - 0119
600 r4ie-ao e Ev2 . con -I
Project Name/Description:
Sage Project #
Date:
Mt. Moriah Property
2021.153
11- .3o zo zi
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, the owner or a duly authorized representative 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. I 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. Please contact Sage to arrange a meeting
prior to visiting the site.
BY: mie Hifff L L6.000reeD BY:
Print Name of Landowner or
Legal Representative
ignature of Landowner or
Legal Representative

PUBLIC WORKS DEPARTMENT
STORMWATER MANAGEMENT DIVISION
405 Martin Luther Kiwi., jr, Blvd.
Chapel Hill, NC 27514-5705
Telephone [phone]
Fax [phone]
wwvtownofchape1hllLorg
Stream Determination Request
AUTHORIZED AGENT FOR LEGAL REPRESENTATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCE. ID (PIN) 9$1c2
STREET ADDRESS:
Please print:
Property Owner:
Property Owner,
1-04/
he undersigned, owner(s) of the above described property, do hereby authorize
/elife__of .te514_6-
14
7707
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actor/Agent) (Name of consulting firm if app cable)
to request a stream determination on this property and to act on my/our behalf and take all actions, liwe could
have taken if present, necessary for the processing, issuance and acceptance of the stream determination for
this property,
Property Owner's Address (if different
Owner Telephone:
ha
property above):
Email:
We hereby certify the above information submitted is true and accurate to the best of aur kno
-er 'zed Ngnature
Owner Authorized Signature
Contractor/Agent Authorized Signature
Date
Date
Date
e,
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Version 212112017

PUBLIC WORKS DEPARTMENT
STORMWATER MANAGEMENT DIVISION
405 Martin Luther King, jr. Blvd.
Chapel Hill, NC 27514-.5705
Telephone [phone]
Fax [phone]
wwwtownofchapethilLorg
Stream Determination Request
AUTHORIZED AGENT FOR LEGAL REPRESENTATION FORM
PROPERTY LEGAL DESCRIPTION:
PARCEL. ID (PIN) 113 4500_95 6 09_5
STREET ADDRESS: 54.304:/e0 itor 4/0
Please print:
Property Owner:
Property Owner
The undersigned. owner(s
(Co
'4/4g14,
riAgent)
le above described property, d hereby authorize
C04 sox, p"h
Narne n consulting flrriif applicable)
to request a stream determination on this property and to act on my/our behalf and take ail actions, litive could
have taken if present, necessary for the processing, issuance and acceptance of the stream determination for
this property.
Property Owner's Address (if different than property above):
if
Owner Telephone: I )
We hereby certif
Email:
the above informationsubrnitted is true and accurate to the best of our knowledge.
ner Authorized Signature
Owner Authorized Signature
Contractor/Agent Authorized Signature
Date
Date
Date
Version 212112017
7'70 7