20231245 Ver 1_Sutton_LOA_Signed_20230627

LANDOWNER AUTHORIZATION FORM
PROPERTY LEGAL DESCRITION:
Deed Book: On I Page: as . County:
Parcel ID Number: I - G — v
ril
Street Address:
Property Owner (please print:r�/� cQ p
Property Owner (please print):_ "Cq i 1t -
e_m \I eA
The undersigned, registered property owner(s) of the above property, do hereby authorize
I A of
(C &tractor/Agent/Project Manager)' (Name of Contractor/Agent FirmllAgc
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). I
agree to allow regulatory agencies, including the NC Division of Water Resources, to visit the
property as part of these environmental reviews.
Property Own.ers(s) Address:
(if different from above)
DOw-C V
Property Owner Telephone Number:,'j� --( ��-
Property Owner Telephone Number:
We hereby certify the above information to be true and accurate to the best of our knowledge.
(Property Owner Authorized Signature)
(Prop -ivy Owner Authorized ' nature)
z�_ -_-Ln ,:�
(Date)
?- — -Zo z
(Date)
Name of full delivery staff member (full -deliveries) or DMS project manager (design -bid -build).
'Name of company (full -deliveries) or DMS (design -bid -build).