71889D - Jeloudarzadeh

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3CAMA / ❑ DREDGE & FILL I '\ +� 5 NO 71 889
A B
3EN ERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environmental Quality
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC a . 2 SU U
+ n El Rules attached.
it Name KU ,�t� p� rZA OQ.i(� Project Location: County f ✓A
t 10 L, \ � k n - `z (ny I ,n O r . Street Address/ State Road/ Lot #(s)
States ZIP
(2�) E-Mail (Y\0 @ft1u1,d�,:.ek ,I `� Subdivision
ied Agent c l� W < 1J City n cee^ Q6f 4c V\ ZIP_LYJI,
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ing permit may be required by: C)Cezd' \ ��L �72ac ❑ See note on back regarding River Basin i
Local Planning lurisdiction) t

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: IA Q j
Mailing Address: 6,(( �Ffl ('IVQ- dye x
Phone Number: �) , CO �� Wzt < j
Email Address: 4 /Vj�,,S et- \mac`' li _ Q0 �^^
I certify that I have authorized kcd %
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
hqL-,--cA
at my property located at oS f�zl�G
in-15� County. - - -
/ furthermore certify that l 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 Oipfr Infonnation:
Signature
G U� 64a
Print
(o'rp Type Name
Title

Parcel ID: 257FC04012
Parcel PIN: 106519600184
Calc. Acreage: 0.20
Legal Description
L-19 B-6 S-D 0.201AC OIB PLAT Z/50
Owner Information
c Owner Name:
JELOUDARZADEH MO
Mailing Address:
■'�, 16211 PINE THORN DR
r
HOUSTON, TX 77095
Deed and Plat References
Deed Book:04393
Deed Page: 1285
Plat Book:
Plat Page:
Parcel Photo
Zoom to
251" RA