Hines, Benjamin

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®CAMA / I_ DREDGE & FILL y 1 l(\) No. 75963 A B C D
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As autho zed by the State of North Carolina, Department of Environmental Quality j
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name ) / ) Project Location: County
y } ICJ i Address Street Address/ State Road/ Lot #(s)
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City „I i State t \ {✓ZIP. 'I
Phone # O_,_ E-Mail Subdivision _
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Authorized Agent i `j I j ' ` / City ZIP
Affected ❑CW hEW ❑ A ❑ES ❑PTS Phone# ( ) � River Basin
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Agent or Applicant Printed d Name
Signature •" Pleaseread compliance statementon back of permit*`
Application Fee(s)
Check #
Permit Officer's Printed Name ,
Signature li
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IssWiDa a Expiratio Date

Styron, Heather M.
From: Timmy Brothers <[e-mail]>
Sent: Monday, December 9, 2019 2:01 PM
To: Styron, Heather M.
Subject: Re: [External] Permit Benjamin Hines
2570 Lennoxville Road
Thanks
On Mon, Dee 9, 2019, 1:57 PM Styron, Heather M. <heather.m.styron&ncdenr. oovv> wrote:
Hey Timmy,
What is the address for the property? I can use this email as the request for a Dorian permit. Once it is ready, I will
contact you and you can drop off the agent form and sign the permit.
Heather
From: Timmy Brothers [mailto:[e-mail]]
Sent: Monday, December 9, 2019 12:08 PM
To: Styron, Heather M. <[e-mail]>
Subject: [External] Permit Benjamin Hines

Heather
This is Timmy, I spoke with you last week about a storm permit for Mr Hines. We are ready to proceed with
his dock replacement in the same footprint it currently sits. I have the agent authorization form and hoping you
can help me with the verbage request via email from Mr Hines.
Timmy

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AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: C W N- Vj C,
Mailing address:
2 S `� o L C-tj0 o
- -- "Fo2-x NC, 7 SS 1 (.7
Telephone Number: cl 3 w
I certify that I have authorized iI CC TSG1240 (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 1� 6-ft lCl G4siy-w Pl 0o
at my property located at 2S '-) C3
This certification is valid through
(Property Owner Information)
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Print or Type Name
Title, co. owner or trustee for property
Cl
Date
Date
Telephone Number
Emall-Ad&e s
(date).