23-389 Field Notes

RUY COOPER _
Covrrnr>r �E
ELIZABETH 5.131SER
Secretary,
RICHARD E. ROGERS, jR. NORTH CARat_;�A
Mwelor Environmental Quality 1
DWR Use Only: Project #
Date Received
Buffer Determination Request Form
Property Owner Information
L O"ner Information
a, Name(s) on Recorded Deed
Jeanne Carol Oldemian
Ib, Responsible Party (for LLC)
Ic, Mailing Address 303 Robert Street, Cary, NC 2751 t-3233
Id. Telephone Number 919-608-9483 le_ Email Address j.c.olderman,a)gmail.com
Address of Property: 303 Robert Street, Cary, NC 27511-3233
Project Description (attach plan if available):
i
Consultant/Agent Information
4. Agent/Consultant Information
4a. Name, Company
Melissa Schambs, Berkshire Hathaway HomeServices YSU Realty
4b. Mailing address
109 New Edition Court, Cary, NC 27511
4c. Telephone no.
919-796-9408
4d. Email address
schambsmelissaagmail.com
5. Project and Site Information
5a. Name of project
303 Robert Street
5b. County Wake
5c. Nearest Named Stream
Swift Creek
5d. River Basin Neuse
6. Has anyone from DWR visited the site?
I Y / N
I N
I Staff Name
I Date of Visit?
Attach a map of the site indicating project boundaries on the USGS 1:24,000 Topo and/or MRCS Soil Sury
Please return form Joe Myers
to: 1628 Mail Service Center
Raleigh, NC 27699-1628
Email:
[e-mail]
North Caruhnu t)epanrocui of Gu ironnuntal t?uaLir � Decision of N'alcr Resource�
512 N'onlr Sahsburc Street 11617 \fad S;; icc (-cntcr I Ralcigh. North Carolnri 27699-161 T
919 707.94M

R-

�
Aa
N
J
� J
J N a Y
0 C? O ti
0U� N
v/
rt N
Z m Uzoz o
�VJV1
— w >- J
O
/y
li
O
SON fy O� l02 N8 p�.p �mm N
m 07 v5 V N N M I ':•
M
0.� N
d'p yW�' 7
N� �� � M W �jO aO
co
3 N a► ui =�}�U�va p 0ai'� ai �pc�n E-
�s�.Qa¢a o c N E- g
_
23 vim
»�
Doro��NaOa y rnU y c cmvvaZ a�?a�U=N
�ZZ��GG�������=o��vYOa
wdd�mH Hu.Amw 1 aH ��o�'t�'J2ma<U)0D
-
v
.E
C
2Y3
O
N
ma a
e8i
Z a
QN
C
q
t
Am
.?me
IMPA
FIRIMP
fill
AN
WAS

2
Q
/�}
�
w§%
zmz
U-
)� K Z 0
$z■ e®wQ
mf£ 2 0:■■'co,
k■� _�§$$�
7�$�I�■JM
■\�&2k/aa■
=eaU
'A A
J e
g on
; $ �
§ R
§0cn§
2 4-wM�
It§-§&wL
o2� >mme
� �� � -
#@,-2AooE .
7&�G,6§8�) ,_
Wwm8oE- §w-
M'a zMaef§-$\§
va-
'210
Z�
V
§
E
f
_ 2
2
®A�f
�]2�&
§�k■■
§$/10
|�® 2
2§Z£iK

DocuSign Envelope ID: 0067D877-23A4-42E9-A2B9-17C1E96EF1F4
AGENT AUTHORIZATION FORM
Please note that multiple forms may be necessary if there are more than two owners of the property.
PROPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:
303 Robert Street
Cary, NC 27511
Parcel ID: 0763394613
Property Owner Name(s) — please print:
Property Owner: Jeanne Carol Olderman
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Melissa Schambs , of Schambs Realty Group — BHHS YSU Realty
(Contractor/Agent) (Nam of company1
AKA Berkshire Hatehaway Hnigeservices YSU Realty
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
Property Owners Mailing Address (if different than property address above):
Property Owner(s) Telephone: 19 6 - 483
We hereby certify the above information submitted in this application is true and accurate tothe hest
of our knowledge.
Jeanne Carol Olderman
Authorized Signature
October 12, 2023
Docuftned by:
C'—
A h d,,tre
10/24/2023
Date Date