Floyd, Alexander

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®CAMA / ❑ DREDGE & FILL �It I I� i '�'! "I �.� �� �0. 75020 A B C D
GENERAL PERMIT Previous permit#
CNew [-]Modification ❑Complete Reissue -�Par'fial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Re so rce Commission in an rea of environmental ii concer pursuant to I SA NCAC
❑ Rules ttached
Applicant Name f T �_e, Y _/' v t V/ j �h` l �C' _- Project Location: County '"
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Phone 4 44)
Authorized Agent
Affected
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yes /ono
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Strejt Address/ State Road/ Lot #(s)
Subdivision !—
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Phone # {( ) �t r River Basin
Adj. Wtr. Body (nat /man /unkn
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Agent or Applicant Printed Name
i."
Signature " Pleaseread compliance statement on backof permit"
Application Feels) Check #

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: &gX LD g FybyD
/
Mailing Address: a w r1 J 41
Phone Number: 9) 4 F 1
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
W
at my property located at 151
Ma
in C'fh27C2F�?rCounty.
,Krra-e h u
'T LOff
G
I furthermore certify that I 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:
Sofature
Print or T pe Name
Title
l 6 / Iy
Date
This certification is valid through I Z / -3 / /t4L

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