20231142 Ver 1_Hengsterman LOA_20230808

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
Deed Book: 2342 Page: 435 County: Orange
Parcel ID Number: 9879582378
Street Address: 8318 Walnut Grove Church Road in Hurdle Mills, NC 27541
Property Owner (please print): Robert Edward Hengsterman and spouse, Staci Hawkins
Hengsterman
The undersigned, registered property owner(s) of the above property, do hereby authorize
Wildlands Engineering, Inc. 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 certification(s). We 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: Same
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
(Property Owner Aiithoyized Signature) J T (Date)
*7 /-7 / --z3
Owner Authorized Signature)