HomeMy WebLinkAboutA02 Authorization FormF 'ENVIRONMENTAL
AGENT AUTHORIZATION FORM
U.S. Army Corps of Engineers, Wilmington District
Attn: Tommy Fennel, Chief, Regulatory Division
PO Box 1890
Wilmington, North Carolina 28402-1890
-and-
NC Division of Water Resources, Water Quality Program
Wetlands, Buffers, Streams — Compliance and Permitting Unit
Attn: Stephanie Goss, Supervisor
1617 Mail Service Center
Raleigh, North Carolina 27699-1650
I, the current landowner, lessee, contract holder to purchase, right to purchase holder, or easement
holder of the property/properties identified below, hereby authorize Atlas Environmental Inc to act on my
behalf as my agent during the processing of permits to impact Wetlands and Waters of the US that are
regulated by the Clean Water Act and the Rivers and Harbors Act. Federal and State agents are
authorized to be on said property when accompanied by Atlas Environmental Inc staff for the purpose of
conducting on -site investigations and issuing a determination associated with Waters of the US subject to
Federal jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors
Act of 1899 and Waters of the State including 404 Wetlands, Isolated Wetlands, and other non-404
Wetlands subject to a permitting program administered by the State of North Carolina. Atlas
Environmental Inc is authorized to provide supplemental information needed for delineation approval
and/or permit processing at the request of the Corps or NC DWR Water Quality Program.
Project Name: 5ow't-% 96,4a.,
Property Owner of Record: 1 Wz_ vsµ ��� U&
Contact Name: I\ a4-1* 9WHI. ZL'g5
Address: �sOb �ayoj� I/u�*ky 1 6k 40,9
1 " Address: G�"'i 4 a Okt
Phone/Fax Number: 4d4 366 Geov
Email Address: _I-V''75 6'1 "w" & , �r�w
Project Address: ay Fi.
Project Address: `� Pa''N� 1 ' "� a'�a6a
PVVVt(W—
Tax PIN: 1 vJ %
Signature: zz Iv or 1 v
Date:
ATLAS Environmental Inc.
338 S. Sharon Amity Road, #411
Charlotte, North Carolina 28211
704-512-1206 (o) / 828-712-9205 (m)
jrobertson@atlasenvi.com
www.atlasenvi.com