20230438 Ver 2_2022 - Totten_Land Owner Authorization Form_20230524

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Parcel ID Number: 192403123832
County:
Granville
Parcel ID Number: 192403135554
County:
Granville
Parcel ID Number: 192403145579
County:
Granville
Parcel ID Number: 192403340564
County:
Granville
Street Address: 1510 B College Street (Hwy 15)
Oxford, NC 27565
Property Owner (please print): Lynette G. Totten
The undersigned, registered property owner(s) of the above property, do hereby authorize
Clearwater Mitigation Solutions
(Name of Contractor/Agent Firm/Agency)
to take all actions necessary for the evaluation of the property as a potential stream, wetland and/or
riparian buffer mitigation project, including conducting stream and/or wetland determinations and
delineations, as well as issuance and acceptance of any required permit(s) or certiiication(s). I
agree to allow regulatory agencies, including the NC Division of Mitigation Services (NCDMS), US
Army Corps of Engineers (USACE) and/or NC Division Of Water Resources (DWR), to visit the
property as part of these environmental reviews.
Property Owners(s) Address: 139 Ride Road
(if different from above)
Butner. NC 27509
Properly Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
Owner Authorized Signature). (Date)