20190333 Ver 1_Walker Branch_JD Request_20190312

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION3°`�
By signing below, I authorize representatives of the Wilmington District, U.S. Acmy Corps of
Engineers (Colps) to enter upon the property hei•ein desci•ibed for the purpose of coilducting on-
site investigations, if necessai•y, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undecsigned, am either a dul}� authorized ownei• of i•ecord of the propei-ty identified herein, oi•
acting as the duly authorized agent of the owner of t•ecord of the property.
C . �J���+t-
Print Nan1e
Capacity: � Owner ❑ Authoi•ized Agents
OZ It°I � ZA \°►
Date � _ �
S ignature
E. REASON FOR JD REQUEST: (Check as many as applicable)
� I intend to construct/develop a project or perform activities on this parcel which would be
designed to avoid all aquatic resources.
� I intend to construct/develop a project or pecform activities on this parcel which would be
designed to avoid all jurisdictional aquatic i•esources under Corps autihority.
❑ I intend to construct/develop a project or perforin activities on this parcel which may
requit•e authorization fi•onl the Corps, and t11e JD �vould be used to avoid aild ininilnize
inlpacts to jurisdictional aquatic i•esources and as an initial step ii1 a firture permittiilg
process.
0 I intendto construct/develop a pt•oject or perfor�n activities on this parcel �vhich may
require authorization fi-om the Corps; this request is accompanied by my pei•mit application
and the JD is to be used in the permittin� process.
�[ intend to construct/develop a project or perfoi•m activities in a navigable �vater of the
U.S. wllich is included on the disti•ict Section 10 list and/or is subject to the ebb and t7ow of
the tide.
� A Cotps JD is required in oi•der obtain my local/state authoi•izatioll.
� I intend to contest jurisdiction over a particular aquatic resource and request the Corps
cor�irm that jurisdiction does/does not exist over the aquatic resource on the parcel.
� I believe that the site may be coinprised e«tii•ely of di•y la�ld.
� Other:
Foi• NCDOT rec�uests followii�g tlie ctiri•ent NCDOT/USACE pi•otocols, sl.ip to Part E.
If there are multiple parcels o��vned by diffei•ent parties, please provide tlie following for eacli additioi�al parcel on a
continuation slleet.
' Must provide agent authoi•ization form/letter signed by owner(s).
Version: May 2017 Page 3