WO-28-15_Swann, Ann_20151112

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
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Mailing Address:
I certify that I have authorized (agent) �5 e( T7 1'Y'), J to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) � t I d
at (my property located at) 13 A
This certification is valid thru (date) a— I yye _ 4 k)
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Property Owner Signature
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IOPERTY OWNER STATEM8NT
The applicant described to me as shown below, the development he/she is proposing in that
location and:
I have no objection to this proposal: I do have objection to this proposal:
Description and/or drawing of proposed development: ,�CO �14
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The applicant described to me as shown below, the development he/she is proposing in that
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I have no objection to this proposal: I do have objection to this proposal:
Description and/or drawing of proposed development: AJY-t-0
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Signature:'- Name: 5Q77- pNi Arl-,,-
Phone Number: 252 -::,?L9 c Date: % 136'
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