72271D - McNeill

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:Mc NC-i k
Mailing Address:
Phone Number:
0 2 ry "n o I pY ,✓ c,
IN �1V\.& 2�N-6r NC_ Z4s4/o'�
Email Address: e;1 � �►�a.�-�,,,, 411CC4_e c ;?A/ ,
I certify that I have authorized ��5� Y�G, ✓,k e seyyi �-o� L L L,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the fo(ll'o�wliing� proposed development: a, r' lc i A -a
V (��G1L�'rVr-pM/�C 8-c v�ic-�G �G-✓� r1 C (mil d� �1 r5 C.�r`G� GV OSS by
at my property located at -% 0o Wa4r%% Llc. g1v G1
in N County.
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.
Propert wner Information:
Signature
Print or Type Name
Title
Date
This certification is valid through /

Domestic
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