Barnes, Julia

A
C;CAMA / —1 DREDGE & FILL No. 74415 A B C D
GENERAL PERMIT Previous permit#
ONew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality i / +/ ( I
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC i / - -
I ❑ Rules attached.
Applicant Name_ Project Location: County
Address t- h U l // '
City Li �n< — State ZIP
Phone # (t ff (' " E-Mail
Authorized Agent i , % ✓<"__
Affected DCW' DEW 6PTA El ES ❑PTS
AEC(): D 0EA ❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS:
l ORW: yes/1 no PNA yes //n/'o
Street Address/ State Road/ Lot #(s)
I
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body 1;l ✓ (nat /man /unkn)
J
Closest Maj. Wtr. Body
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Bent or Applicant Printed Name
Signature *r Please read compliance statement on backofpermit*'*
Application Fee(s) Check #
PermitOffcer's Printed Name
Signature
IssuingrDate ratioExpi— i ate

AGENT AUTHORIXATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit; J vt./A 1pQNFS
Mailing Address: y/a9 Zoo>
/V,lrz-NPrt, /V G Z 770'
Phone Number: �/% `%/9 — Row
Email Address: lJiovYrur�(� ,sri s r.o • �°r'
I certify that I have authorized �NnQF FRS
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the (following proposed development:-Pelce/o�G Foy//d/T% /i✓
at my property located at / 0 ���/�pG D ��t ✓�
in CAC- i" jCounty.
l furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
] signature
.Print or Type Name
Title
Date
This certification is valid through 3 / / G I ZO