20150995 Ver 2_02_Agent Authorization - Town Executed_20190328

Name:
Addres
� F���c�r.�_�iar�K�
1/a r; �a, n1c z �s� �
Phone: `7(`I -�5� -1�lO1 ---'7"�cLbp�g,a.l (-o✓�iztc f =Trur..�`.�+e�hctisoh
Project Name/Description: Park Depot Greenwati
Date: �/�/� �
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
Attention: James Lastinger, USACE
Field Office: Raleigh Regulatory Field Office
Re: Wetland Related Consulting and Permitting
To Whom It May Concem:
Td.J„�VY� �nal
� 9tS^753-tD3g
The Town of Fuquay-Varina hereby designates and authorizes Kimley-Horn and Associates, Inc. to acY
in my/our behalf as my/our agent solely for the purpose of processing Jurisdictional Determinations,
Section 404 permits/Section 401 Water Quality Certifications applications, and Neuse River Basin
Riparian Buffer Determinations, and to furnish upon request supplemental information in support of
applications, etc. from this day forward until sL�ccessful completion of the permitting process or
revocation by the owner.
In addition, 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
40A of the Clean Water Act and/or Section 10 of the Rivers and Hazbors Act of 1899.
Authorized this the � day of �, � O/s ,
i�o�avr� G.�,;%c�nel(
Print Prope Owner's N`am�e
TOcJn o�' ��q.q1.t4�— yoPi�iGjl1�-
U
Cc: Karen Higgins
NC Division of Water Resources
401 & Bulfer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
�
�i .�.a►.�- � '
' �- � _
AGENT AUTHORIZATION FORM