Stephens, WIlliam

=CAMA / El DREDGE &FILL 1 � �. i � � ( 1 I l i / No 74921 A B C D
GENERAL PERMIT Previous permit#
New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
As autho izocl by the State of North Carolina, Department of Environmental Quality
and the oastal Resources C mmission in an area of environmental concern pursuant to 15A NCAC % +
f + ❑Rulesattached. '
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,agent or Applicant Printed Name
Signature a" Please read compliance statement on b tk f permit'ts'
Application Fee(s) Check#

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
�,n�c/G^ NG 276/S
Phone Number:
Email Address: s/� �nfJ r p '4 �c. cc✓H
I certify that I have authorized HNgef
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development
at my property located at
in 0,49Texr, County.
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:
sionature z
Print or Type Name
Ol-�^/
Title
/ S
Date
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This certification is valid through I /' I

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