20181064 Ver 1_Agent Authorization_20180802

IKS
�1 � " 41, �: i
4
5oil,'Mtcr, & Environment
Group
32 t6 Byer Drive
Suite t3
Raleigh, NC 27607
[phone]
(9 19) 899-91til1fax)
AGENT AUTi-IORIZATION FORM: PERMIT"l'ING
All inrormation to be tilled in by the current landowner:
We, the current property owner, hereby authorize _Scott J. Frederick_ of Soil, Water. & Environment Group,
PUC of Raleigh. North Carolina (consaltattl) to act its agent on bchnlf of Wim.l a ZYr"es
(Landowner) in the praccssing of permit applicalion
s5,to furnish tr on nqucst suppicnietttal infomaation in support
of applications, cte., from this day forward. 'flus Is day of .��
This notification supercedes any previous correspondence concerting the agent for tlsis project.
NOTICE: This authorization, for liabiIily and prufessiunal couitesy reasons, is valid only for government officials
enter the property when accompanied by Scott J. Frederick_ of'Soil, Water, &. Envirormment Group, PLLC of
Raleigh, North Carolina (consultant) stall: You should call _(919) 831-1234 at _Raleigh_ (office) or _(919)
368-2029Y (mobile) (consultant) to arrange a site ntacting prior to visiting the site.
USACE, Wilmington District
l
(Z.► lcryA_ Field Office (Ashevill a c1 t Washington, or Wilmington)
Attn: %(USACE POC)
�fn f� Ly'r7r ES r►r/F . Ln e . / ��u-rz � Te��>• �t-r.tt�n:
Landowner (Print)
Address. j / 7 t
�C k'i �c Il1Y: H a rV L
F
City, State Zip
Phone
Project Name/Descr'lstion:
r; jrt-
Landowner (Signature) Date
Cc: Cc:(Consultant)
NCDENR-DWQ 6yyt:; 6to-19
1650 Mail Service Center
Raleigh, NC 27699-1650