71887D - Miller

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S,uraich Addro--,L,--; or Parcel If
(-V 1 7 ICA N.,O[U
2018 Tax Card
2017 Tax Card
2016 Tax Card
Parcel Information
Parcel ID: 257FC04
Parcel PIN: 106519
CaIc. Acreage: 0. 1
21;
Legal Description
- 0L-20
B-6 S-D 0.154,
•
Owner Information
Owner Name:
E E-
MILLER DAVID
MILLER KAREN M
Mailing Address:
11506 BRANGUS L
MINT HILL, NC 28:
Deed and Plat RefE
250- R
Deed Book: 03805
Zoom to
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: �% 5J0� �r�•� Gc.S L A��
Phone Number:
Email Address:
certify that I have authorized �/ L" AA,)
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: '�-p 1i9. D47'
at my property located at�
in ^'� �' r << County.
I furthermore certify that I 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:
Signature �/�
Print or Type Name
Title