20230499 Ver 1_Agent Authorization Letter_20230411

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book: DB1566 Page: 608 County: Buncombe
and
Deed Book: DB6255 Page: 1651
Parcel ID Number: 0617-97-0249
Street Address: 34 Chestnut Hill Rd, Black Mountain, NC 28711
Property Owner (please print):
SADIE E CLEMENTS
CHARLES M FORTUNE III (LE)
SANDRA OWNBEY FORTUNE (LE)
(Owner names as specified on deed)
The undersigned, registered property owner(s) of the above property, do hereby authorize
Buncombe County Soil & Water and/or Wildlands Engineering, Inc. (Wildlands) to conduct stream
and/or wetland determinations and delineations, and for the issuance of, application for and/or
acceptance of any required permit(s) or certification(s). I authorize land disturbing activities in
association with project assessment activities and construction. I agree to allow regulatory
agencies, including the US Army Corps of Engineers, to visit the property as part of these
environmental reviews.
Property Owners(s) Address: 26 Chestnut Hill Rd, Black Mountain, NC 28711
(if different from above)
Property Owners(s) Address: list other
(if different from above)
Property Owner Telephone Number:
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
t� f -tea, .. � � c�62-�Ta el �'�q:
or Authorized Signature) (Date)
(Property Ow r or Au orizi ature)
(PropeW dwh6r or Authorized Signature) (Date)
(Provide scanned copy to jmclean a wildlandseng.corn or original copy upon request)