68596D - Holt

Consent for Use of General Permit 7H.1200
Lot Number/Address: S�0 �� X 1f. �"�ec&c
County: Subdivision:
Criteria:
(check all that apply)
Primaiy Nursery Area.
Less than 2.Oft deep.. .
❑ Greater than 2.Oft but less than 3.Oft.
o Submerged Aquatic Vegetation.
La Bottom habitat.
Comments:
` `kj K____ 1 too JIA5 Y bpi SF �i� �o �I"1 a sc c�; _.. KaO' Ab„
cb 1a ta,� -1.15 2 L
Decision:
�ue General Permit
o Elevate to Major Permi
4-
N , ivision of e Fi heries Representative Date

17 03:42p DMG
RECEIVED 11/08/2017 03:11PM
7043604454 p.1
Nortrt Carolina Deoartment o7 E^vlrorrnent and Natural Resources
N C. Oivistor of Coasta Management
John E. Sk
Sere
AGENT AUTHORIZATION FORM
Date 11-9-17
Name of Property Owner Applying for Permit Name of Authorized Agent for this prq t f
.,Z��J!/G? /►�t _, .f�.t/� � --- - .ems
Owners MafJfng Address Agents Ma1Nng Address:
Ernad
Prone
ze^!ry that I have authorized the agent !.*Stec above to act on -ny behalf. for the purpose of applying
for and obtaining alt CAMA Permits necessary to install or construct the foll6wng (activity)
For my ofooerty locoed at 717 jtAWISZ —
TNs cerldir-aton is valid 1 year from (date)

r 01 Vtc', .-iry
��
NJ) . Carolina Deoarrrert E^virp^rnent and Naturaj Resources
N C Divisior of Coastal Management
AGENT AUTHORIZATION FORM
Date \\-_1-l_
John Ecc..SuS
sac
Name of Property Ap trig for Permit Name of AuthorIz.,ed Agent for this project'
- �- n
Owners Mailing Address Agent's Mailing Address:
4 (Q Z
CzXrYC-
cr,��P R)oI 515
Email AC)e V,,
Prone -Lu -
_ert,fv that i have authorized the agent !:steel above to act on ,ry behalf for the purpose of applying
for and obtaining aC CAMA Permits necessary to nstall or construct the following (activity)
Fo,, my property located at
%k v-f1

Jb Js -� rel/ 6?AJ /04'r
GuWdr

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
i. Article Addressed to:
A. Signature
XLs" ❑ Agent
❑ Addressee
B. Received b printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: p No
R d o olr.o4 ery/D
p,
3. Service Type
r][
❑Adult Signature
❑ Adult Signature Restricted Delive ry❑Registered
❑Priority Mail Express®
❑ Registered MaiITM
9590 9402 2021 6123 2954 2❑
Certified Mails
Certified Mail Restricted Delivery
Mail Restricted
❑ Retu
2. Article Number (Transferfnmcervices /ahcn❑
Receipt for
Collect on Delivery Merchandise
❑ Collect on Delivery Restricted Delivery ❑ Signature ConfinnationT
016 0 91 0 2 1223 13 7 5
11 Insured Mail
7 Insured Mail Restricted Delivery
❑ Signature Confirmation
Restricted Delivery
P$ Form 3811, July 2015 PSN 7530-02-000-9053
(over $500
Domestic Return Receipt
1 ■ Complete itert7; 2, and 3.
i ■ Print your namelind address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
6 � v
r'
-Jo qpeows'ex 1✓ r
C'r9. ,�SS�'
IIIIIIIII IIII IIIIIIIIIIIII IIIIIIIIII II III II III
9590 9402 2021 6123 2954 58
A. Signature
f , _ ❑ Agent
19 Addressee - .
P_-Raceived by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Adult Signature
❑ Adult Signature Restricted Delivery
❑ Certified Mail®
❑ Certified Mail Restricted Delivery
❑ Collect on Delivery
❑ Priority Mail Express®
❑ Registered MaiITM
❑ Registered Mail Restricted ?
Delivery
❑ Return Receipt for
Merchandise