71251A_Dougls & Holly Traxler_20181116

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[ICAMA / ❑ DREDGE & FILL No 71251 ® g C D
GENERAL PERMIT Previous permit #
[New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules attached.
Applicant Name Tfo x It ✓
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Address :�y4huo Ci
City__CuV � State VA ZIP
Phone # () E-Mail
Authorized Agent
Project Location: CountyC � f V, . I, *L k
Street Address/ State Road/ Lot #(s) q 4 )L, S. 4c,eWeyatj
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Subdivision�,�✓,1� -c f :5ko ✓t '-.
City ory 1 to ZIP 91
Affected ❑ Cw )*W XPTA ❑ ES ❑ PTS Phone # ( ) River Basin o
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): El PWS: at Adj. Wtr. Body .. �� 5'_'d ( an /unkn)
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Agen plicant Printed Name
Signatu Please r ad compliance statemen n back of permit**
Application Fee(s) Check #
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Permit s rinqd Nanis
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Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ///t7-1;--/ -Z.-,A 9
Name of Property Owner Applying for Permit:
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Mailing Address: nN -� � �� :
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I certify that I have authorized (agent) 9/1-c � 5. Ajag*44 ,je ewe to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
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at (my property located at)
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This certification is valid thru (date)
Property Owner Signature ' Date

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