20220980 Ver 1_More Info Received_20220916

Name:
Address:
Phone:
Email:
AGENT AUTHORIZATION FORM
All Blanks to Be Filled in By the Applicant or Legal Representative
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Project Name/Description: Buckhorn Creek
Sage Project # 2021.167
Date:
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
P.O. Box 1890
Wilmington, NC 28402
NC Division of Water Resources
3800 Barrett Drive
Raleigh, NC 27609
Attn: Attn:
Field Office: Regional 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) and 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. subject to Federal jurisdiction under
Sections 401 and 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. Please contact Sage to arrange a meeting
prior to visiting the site.
BY: 4,40 BY:
Print Name of Landowner
Signatur:f• f Landowner r
Legal Representative Legal Representative