20240034 Ver 1_03_SIGNED_Chatham_St_Agent_Authorization_Form_20240105

DocuSign Envelope ID: D244B812-72DB-4069-AFE2-BBD87102E5AA
AGENT AUTHORIZATION FORM
Name: Chelsea Stern
Address: 316 N Academy St, Cary, NC 27513
Phone: [phone]
Project Name/Description: Connecting Cary Sidewalks — West Chatham Street
Date: January 28, 2022
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
Field Office: Raleigh Regulatory Field Office
Re: Wetland Related Consulting and Permitting
To Whom It May Concern:
The Town of Car v hereby designates and authorizes Kimley-Horn and Associates, Inc. to act in my/our
behalf as my/our agent solely for the purpose of processing Jurisdictional Determinations, Section 404
permits/Section 401 Water Quality Certifications applications, and Neuse River Basin Riparian Buffer
Determinations, and to furnish upon request supplemental information in support of applications, etc.
from this day forward until successful completion of the permitting process or revocation by the owner.
In addition, I, the undersigned, a duly authorized owner of record of the property/properties identified
herein, do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps)
to enter upon the property herein described for the purpose of conducting on -site investigations and
issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction under Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899.
Authorized this the 17 day of Janua
Chelsea Stern
Print Property Owner's Name
Cc: Shelton Sullivan
NC Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1650
2023
DoeuSigned by:
CDctig� �St�ti
Property Owner's Signature