20180412 Ver 1_Agent Authorization_20180322

Phone: [phone] www.SoilServices.us Fax: [phone]

SOIL SERVICES, PLLC
PO BOX 91115  RALEIGH, NC  27675

AGENT AUTHORIZATION FORM
All Blanks To Be Filled In By The Current Landowner

Name: Lea Ricks (Homes by Dickerson)

Address: 7101 Creedmoor Rd, Ste 115, Raleigh, NC 27613

Phone: [phone] Project Name/Description: MacTavish Lot 23

Date: 3/21/18

NCDENR – DWR USACE-Raleigh
Attn: Stephanie Goss Attn: Tasha Alexander
2321 Crabtree Blvd. 3331 Heritage Trade Dr. Ste. 105
Raleigh, NC 27604 Wake Forest, NC 27587

Attn: Field Agent

Field Office: Raleigh

Re: Stream/Wetlands Related Consulting and Permitting

To Whom It May Concern:

I, the current property owner, hereby designate and authorize Soil Services, PLLC to act in 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. The 21 day of March .

This notification supersedes any previous correspondence concerning the agent for this project.
NOTICE: This authorization, for liability and professional courtesy reasons, is valid only for government
officials to enter the property when accompanied by Soil Services staff. You should call Soil Services to
arrange a site meeting prior to visiting the site.

Print Property Owner’s Name Property Owner’s Signature

cc: Mr. Stephanie Goss cc: Mrs. Sarah I Menser
NCDENR – DWR Soil Services, PLLC
2321 Crabtree Boulevard PO Box 91115
Raleigh, NC 27604 Raleigh, NC 27675

cc: Mr. Tasha Alexander
USACE-Raleigh
3331 Heritage Trade Dr. Ste. 105
Wake Forest, NC 27587
Lea Ricks