20150995 Ver 2_02_Agent Authorization - Town Executed_20190403

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Date: �/�/� �
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
Attention: James Lastinger, USACE
Field Office: Raleigh Regulatory Field Ofiice
Re: Wetland Related Consulting and Permitting
To Whom It May Concern:
The Town of Fuquay-Vazina hereby designates and authorizes Kimley-Horn and Associates, Inc. to act
in my/our behalf as my/our agent solelv 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 forwazd until successful completion of the permitting process or
revocation by the owner.
ln addition, I, the undersigned, a duly authorized owner of record of the property/properties identified
herein, do authorize representatives ofthe Wilmington District, U.S. Army Corps ofEngineers (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 Hazbors Act of 1899.
Authorized this the � day of � e2 0 fs .
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Print Prope Owner's Name Prope Owner's Signature
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Cc: Karen Higgins
NC Division of Water Resources
401 & Buffer Permitting Unit
1650 Mai] Service Center
Raleigh, NC 27699-1650
AGENT AUTHORIZATION FORM