20150097 Ver 1_More Info Received_20150126

Strickland, Bev
From:
Sent:
To:
Subject:
Attachments:
Bev,
For Project 15 -0097
Thanks,
Sheri
Montalvo, Sheri A
Thursday, January 29, 2015 9:42 AM
Strickland, Bev
FW: Drainage improvement at carter living center
1- 23- 15-- USACE- Agent- Authorization - Form.pdf
From: Brian Leonard [ma ilto :brlengineeringCd)earthl ink. net]
Sent: Monday, January 26, 2015 1:59 PM
To: Montalvo, Sheri A
Subject: RE: Drainage improvement at carter living center
From: Montalvo, Sheri A [ mai Ito: sheri.montalvo(d)ncdenr.gov]
Sent: Monday, January 26, 2015 12:36 PM
To: brlenaineerinaCa)earthlink.net
Subject: Drainage improvement at carter living center
Importance: High
Brian,
We have received the PCN for above referenced project. With your name as signer for the application we will require an
agent authorization form to be filled out and I have attached one for your use. Once completed please send back to me
either via email at sheri.montalvo @ncdenr.gov or you can mail it to:
Sheri Montalvo
401 & Buffer Permitting Unit
NCDENR- Division of Water Resources
1617 Mail Service Center, Raleigh, NC 27699 -1617
This project will be placed on hold until receipt of the form.
Thank you for your help,
Sheri Montalvo
Phone: [phone]
Email: sheri.montalvo @ncdenr.gov

E -mail correspondence to and from this address may be subject to public records laws and may be disclosed to third
parties.

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO
STREET ADDRESS: 303 Carver Street
Durham, NC 27704
PARCELID: PIN: 0833 -13 -14 -3484
Please print: Durham LLC (formerly Durham Limited Partnership)
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Brian R. Leonard, PE, PLS of
(Contractor j Agent)
BRL Engineering
(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):
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: i 11 If Date: 11