20170110 Ver 2_Agent Authorization Form_20181206

SAGE
E C O L;OGICeL
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AGENT AUTHORIZATION FORM
All Blanks to Be Filled in By the Current Landowner or Legal Representative
Name:
Address: 97-0 Ff til cr_a✓ y D?-
fJC 2SfJLJ
Phone: p SIM3-9388
Email: �C i 5No12. ICA-n1E�Zltl (-A4 4 cptl
Project Name/Description: 1111 RDI Center Drive
Sage Project # 2018.07
Date: I+41If3
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
P.0, Box 1890
Wilmington, NC 28402
Attn:
Field
Re: Wetlands and Streams Related Consulting and Permitting
To Whom It May Concern:
I, the undersigned, the owner or a duly authorized representative of record of the property/properties identified
herein, do authorize representatives of the 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. I also hereby designate and authorize Sage Ecological Services 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 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 Sage staff. Please contact Sage to arrange a meeting
prior to visiting the site.
BY: ER)BY:
Print Name of Landowner or Sig ature of Land caner or
Legal Representative Legal R.epreren anve