20151131 Ver 1_Jurisdictional Determination_20151102

Jurisdictional Determination Request
D. PROPERTY OWNER CERTIFICATION
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.
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Property Owner (please print) Date
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Propry Owner Signature
E. JURISDICTIONAL DETERMINATION TYPE
Select One:
I am requesting that the Corps provide a preliminary JD for the property identified herein.
This request does include a delineation.
I am requesting that the Corps provide a oreliminary JD for the property identified herein.
This request does NOT include a delineation.
I am requesting that the Corps investigate the property/project area for the presence or
absence of WoUSs and provide an approved JD for the property identified herein. This
request does NOT include a request for a verified delineation.
I am requesting that the Corps delineate the boundaries of all WoUS on a property/project
area and provide an anoroved JD (this may or may not include a survey plat).
I am requesting that the Corps evaluate and approve a delineation of WoUS (conducted
by others) on a property/project area and provide an approved JD (may or may not
include a survey plat).
For NCDOT requests following the current NCDOT /USACE protocols, skip to Part E.
s Waters of the United States
Version: December 2013 Page 4