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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �
C—k rV 5 40A-
N rtY M � �
Mailing
Address:
Phone Number:
Email Address:
I certify that I have authorized
I,Iv 5 . 02G Ik
I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: eLTIO- >
GY 5A-Kib3 r-Z�wS -►- C7-4r' 74Z .AIE�D.f,
at my property located at
i0i"'i �M�v < � County.
I 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:
,Pgnature ( ,
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Title
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Date
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This certification is valid through 1
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