67968D - Knott

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ENERAL PERMIT Previous permit #
ew ❑iModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources _ !!1 1 I '
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC o f' l r , 45 6 o (6 �n -I Z OC
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❑ Rules attached.
rt Name C^ 1N VI U Project Location: County h 5� z K
A CA L 0 Street Address/ State Road/ Lot #(s)
4 State -L ZIP
k (4- /q)-11 U- �' E-Mail Subdivision -
Eed Agent Jo 61 ( Ate sy
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%ttached: yes
ng permit may be required by: 1-0 L'-A 01 S1. r 1 u `'` ❑ See note on back regarding River Basin r
Local Planning lurisdiction)

CCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis Dee Freeman
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner APPI ng for Permit: Name of Authorized Agent for this project:
IEU
-- '2,11 sue- i 7 - 2 t���
Owner's Mailing Address:
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Phone Numberr �Q �7Q' QUO off,
a39 •�['�o • "?SSG
Agents Mailing Address:
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Phone Number (,?,0) sa ;7
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at And' .S 11 n Q : r , 610 e i
4
This certification is valid thru (date) (-OmD�6& mm4\ rs
Property Owner gnature Date

U.S.
Postal
Service'"
CERTIFIED
MAIL°
RECEIPT
Domestic
Mail Only
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delivery
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Postal
CERTIFIED 0 RECEIPT
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Domestic Mail Only
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OCEAN ISLE BEACH, NC 2.- �4q
S- 77
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Certified Mail Fee
ti
s $3.30
i14,`,4
ra Services & Fees (check bax, eon tee o te)
❑ Return Receipt (hardcopy) $
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❑ Rim Receipt (electronic) $ ——
❑ Certified Mall Restricted Delivery $
Postmark
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❑ Adult Signature Required $ i V. 6 r
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Adult Signature Restricted Delivery $
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Postage
Total PoLand.47
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