20140574 Ver 3 _AgentAuthorization _20160118

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TIMMONS GROUP
AGENT AUTHORIZATION and
PROPERTY OWNER CERTIFICATION FORM
All Blanks to be Filled in by Current Landowner
The Department of the Army NCDENR — Division of Water Resources
US Army Corps of Engineers 401 & Buffer Permitting Unit
Wilmington District 1650 Mail Service Center
PO Box 1890 Raleigh, NC 27699-1650
Wilmington, NC 28402-1890
To Whom It May Concern:
I, the undersigned, current property owner designate and authorize representatives of Timmons Group,
Inc., to act on my behalf as my agent in the processing of permit applications, to furnish upon request
supplemental information in support of applications, etc., from this day forward.
This the —113 day of 20 66.
(number) (Month) (Year)
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.
This notification supersedes any previous correspondence concerning the agent for this project.
Project Name: 7 �L3 Location: rva "t &L,t
Property Owner's Name (Print): iLA16 L4c--
Property Owner's
Property Owner's Mailing Address: o Dox 39 got � t4_' /1e— d700
Property Owner's Telephone: (7i 1 —53 r —306" Fax No.
Property Owner's Email Address: GfJ P6,� 0 _Y4doo,
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TIMMONS GROUP
AGENT AUTHORIZATION and
PROPERTY OWNER CERTIFICATION FORM
Ali Hlcanky to be Filled in byAlUaliccant
(When Applicant has property/properties under contract to
purchase from duty authorized owner of record)
The Department of the Army
US Army Corps of Engineers
Wilmington District
PO Box 1890
Wilmington, NC 28402-1890
To Whom It May Concern:
NCDENR — Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
I, the applicant, hereby designate and authorize representatives of Timmons Group, Inc., to act on my
behalf as my agent in the processing of permit applications, to furnish upon request supplemental
information in support of applications, etc., from this day forward.
This the 13 day of :KJd WW -2Q 1=6 .
(number) (Month) (Year)
I, the undersigned applicant, with written authorization from 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.
This notification supersedes any previous correspondence concerning the agent for this project.
Project Name;: { ( �y1 Location: GWf r1 .41,Of- NL
Property Applicant's N
Property Applicant's S
Property Applicant's Mailing Address: r o be] 39 �; Aot t 6L3' as .le— 2 zUo
Property Applicant's Telephone: 1 iT—,5V—3;6�'r76r-y Fax No.
Property Applicant's Email Address: G 0,1,0 T �t1t K' -!(Loo, 49.1
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