20180511 Ver 2_01-Signed Agent Authorization Form (2023)_20230510

AGENT AUTHORIZATION FORM
All Blanks to Be Filled in By the Current Landowner or Legal Representative
Nance, 6-1b
Address: 6 e
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Email:
Protect Narne/Descriptiow __._ O.ak Park Subdivision . . . .....
Sage Project # 201630
Date: 3
The Department of` the Army NC Division of Water Resources
U.S. Army Corps ofErigineers, Wilmington District 3800 Barren Drive
P.O. Box 1890 Raleigh, NC 2�7609
Wifirlington, NC28402
Attu: Attu
Field Office: _.......-Raleigh RFO, Regional Office: Raleigh RC),
Re-. Wetlands and Streams Related Consulting and Permitting
To Whom It May Concern!
1, the undersigned, the owner or a duly authorized representative of record of the property/propwics identified
herein, do authorize representatives of the U.S. Anny Corps ol"Engincers (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 detenilination associated with Waters of the U,S, subject to Federaijurisdiction 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 nay behalf as my agent in the processing of permit
applications, to furnish Upon req=St supplemental inforniatiOn ill SUPPOrt ol'applications, etc, from this day forward.
This notification supersedes any previous correspondence concerning the agent fur 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� BY:
Print Name of' Landowner or
Legal Representative
Signature
, ' nature of ' Landowner or.
Legal Representative