20231675 Ver 1_The Nature Conservancy (TNC)_AGENT_AUTHORIZATION_FORM_UT Three Top Creek_Ashe Co_signed_MNS_20231206

AGENT AUTHORIZATION FORM
US Army Corps of Engineers
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 0315501
STREET ADDRESS: Bluff Mountain Natural Area, North of 665 William T Calloway Road, Todd, NC
28684
Latitude: 36.366, Longitude:-81.581
Please print:
Property Owner: The Nature Conservancy
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Laura yoga of the US Fish and Wildlife Service, Asheville ESFO (Contractor/Agent) to apply for
Nationwide Permit No. 27 to authorize stream restoration practices in reference to the January
16, 2023 final design for an "Unnamed Tributary of Three Top Creek Streambank Stabilization
TNC Reach and Rognstad Reach in Todd, NC, by Melanie Carter, Engineer, Brushy Fork
Engineering Division, PLLC. To 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 Owner's Address (if different than property above):
334 Blackwell Street, STE 300, Durham, NC 27701 Email: [e-mail]
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: �"/ L Date:

The Nature
Conservancy (TNC)-AGENT-AUTH
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