20240361 Ver 1_03_TrinitieTrail_AA_Signed_20240304

Name:
Address:
AGENT AUTHORIZATION FORM
s
Phone:
:1
Project Name/Description: Structure Replacement of Trinitie Trail Culvert
Date: & — 6_ Z 3
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
Attention: Shane Staples
Field Office: Washington Reeulatory Field Office
Re: Wetland Related Consulting and Permitting
To Whom It May Concern:
, K�C_
The Town of Southern Shores 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 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,l, 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 16Aday of _7�-n p ZQ2_3 .
Print Property Owner's4 e
Cc: Stephanie Goss
NC Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1650
Propel-0- er's S �ure