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HomeMy WebLinkAbout20130327 Ver 1_CAMA Permit Application_20130328ALVIWIF 2 NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Pat McCrory Braxton C. Davis Govemor Director MEMORANDUM TO: Ms. Cyndi Karoly Env. Biological Supervisor Division of Water Quality Wetlands Unit 0 130 32 7 John E. Skvarla, III Secretary FROM: Doug Huggett Respond to Doug Huggett Major Permits Processing Coordinator Morehead City Office Coastal Management Division 400 Commerce Avenue Morehead City NC 28557 DATE: 26 March 2013 SUBJECT: CAMA Application Review APPLICANT: Robert S. and Jeannine B. Saunders PROJECT LOCATION: Project site is located off SR 1319 in Cypress Shores subdivision near Roper, adjacent the Albemarle Sound in Washington County, North Carolina. PROPOSED PROJECT: Applicant proposes to construct a 16.5' long by 6' wide (99) step -down platform adjacent an existing 348' partially covered L -head platform to create a single platform component of 447', and install 2 mooring pilings adjacent the step -down to create a wet slip, resulting in a 3`d mooring for the pier structure. Please indicate below your position or viewpoint on the proposed project and return this form by 15 April 2013. Please contact Kim Hedrick at 252- 948 -3936, if you have any questions regarding the proposed project. When appropriate, in depth comments with supporting data are requested. REPLY This office has no objection to the project as proposed. Signed This office has no comment on the proposed project. This office approves of the proposed project only if the recommended changes are incorporated. See attached. This office objects to the proposed project for reasons described in the attached comments. Date U MAR 2 8 2013 943 Washington Square Mall, Washington, NC 27889 Phone: 252 - 946-04811 FAX: 252 - 948 -0478 Internet. www.nccoastalmanagement.net An Equal Opportunity 1 Affirmative Acton Employer I � 1Qa °L° `" ° ' DIVISION OF COASTAL MANAGEMENT FIELD INVESTIGATION REPORT I. APPLICANT'S NAME: Robert S. and Jeannine G. Saunders 2. LOCATION OF PROJECT SITE: 95 Cypress Shores Road East (off SR 1319) in Cypress Shores Subdivision near Roper, adjacent the Albemarle Sound in Washington County, North Carol'na. Photo Index —2006: 134 -1420: R6 2000: 134 -1568: R2 1995: 134 -1420: R6 State Plane Coordinates X: 2,716,500 Y: 806,000 GPS Rover File: F110613A Roper North Quad (upper left comer) 3. INVESTIGATION TYPE: CAMA 4. INVESTIGATIVE PROCEDURE: Date of Site Visits —18 December 2012 and 12 March 2013 Was Applicant Present — Yes (12/18/12) and No (3/12/13) 5. PROCESSING PROCEDURE: Application Received — 25 March 2013 Office — Washington 6. SITE DESCRIPTION: (A) Local Land Use Plan — Washington County Land Classification From LUP — Conservation (water) (B) AEC(s) Involved: EW and PTA (C) Water Dependent: Yes (D) Intended Use: Private (E) Wastewater Treatment: Existing — Onsite septic system Planned — None (F) Type of Structures: Existing — Single family residence, bulkhead, 3 groins & L -head pier structure with two uncovered lifts. Planned — Propose to construct 16.5' long x 6' wide stepdown platform adjacent existing 348 ft2 L -head platform and install 2 mooring pilings adjacent new stepdown to create a wetslip for a total of 3 slips. (G) Estimated Annual Rate of Erosion: N/A Source — N/A 7. HABITAT DESCRIPTION: [AREA] DREDGF,D FTT,T.FD OT 4PR (A) Vegetated Wetlands (B) Non - Vegetated Wetlands Albemarle Sound bottom 99 ft2 (shaded by stepdown platform) (C) Other (Uplands) (D) Total Area Disturbed: 0.002 acres (99 ft2) (E) Primary Nursery Area: No (F) Water Classification: SB Open: NO 8. PROJECT SUMMARY: The applicants propose to construct a 16.5' long by 6' wide (99 ft2) stepdown platform adjacent an existing 348 ft2 partially covered L -head platform to create a single platform component of 447 ft2, and install 2 mooring pilings adjacent the stepdown to create a wet slip, resulting in a P mooring for the pier structure. r Robert S. and Jeannine G. Saunders Albemarle Sound Washington County Project Setting Robert S. and Jeannine G. Saunders have submitted the attached application for a CAMA Major Permit to upgrade their existing L -head pier structure. The project site is located at 95 Cypress Shores Road (off SR 1319) in Cypress Shores Subdivision on the Albemarle Sound near Roper in Washington County, North Carolina. Cypress Shores Subdivision is located on the southern shoreline of Albemarle Sound ±1 mile east of the Community of Mackeys. The Saunders' property is ±1.6 acres in size and consists of two lots at the eastern end of Cypress Shores Subdivision. There is a single family residence on the western lot of their property. The property is vegetated with upland grasses and a few trees and native and ornamental shrubs. To the east of their property is an undeveloped ±31 -acre tract stabilized by a bulkhead, all of which is farmed row crops with an ±75' grassy vegetated buffer area landward of the bulkhead. To the west of their property is a single - family residence with a bulkhead and a storm damaged pier structure. Besides the dwelling, other structures on the Saunders' property .include a bulkhead, three groins, and a partially covered L -head pier structure with two uncovered boat lifts, one of which has a finger pier as access. The pier structure was recently replaced under CAMA General Permit No. 60979 -B issued on 26 November 2012. The authorized structure is an 88' long by 6' wide pier with a 16.5' long by 20' wide (330 ft2) partially covered L -head platform, with an additional 18 ft2 of roof overhang, and a 20' long by 6' wide finger pier access to an existing uncovered 12' long by 12' wide boat lift. There also exists a second uncovered 12' long by 12' wide boat lift adjacent to and west of the L -head platform. The CAMA General Permits issued to the Saunders' for lifts to the pier structure, groins, and new and replacement bulkheads are as follows: 46522 -B issued 24 August 2006, 47729 -B issued 3 April 2007, 53578 -B issued 12 June 2009, and 54789 -B issued 9 March 2010. There are no wetlands on the property for this project. The water depth at the end of the existing pier structure and in the location of the proposed wet slip is -3' to 4 at normal water level (NWL). The Albemarle Sound is classified SB by the Environmental Management Commission and Coastal Waters by the Marine Fisheries Commission. The Albemarle Sound at this location is closed to shellfishing. No SAV have been observed at the project site. Project Description The applicants propose to construct a 16.5' long by 6' wide stepdown platform immediately east of the existing, partially covered 348 ft2 L -head platform, and install two tie pilings adjacent the proposed stepdown to create an ±12' long by ±12' wide wet slip. The wet slip will be located in -3' to 4 deep water of Albemarle Sound relative to NWL. The applicants own a total of ±450 linear feet of shoreline allowing up to 2,000 ft2 shaded impact. The proposed stepdown platform as well as the existing shaded impact by the partially covered L -head platform and finger pier will total 567 ft2. Anticipated Impacts The proposed stepdown platform will shade an additional 99 ft2 of Public Trust Area and Estuarine Water Areas of Environmental Concern (AECs) of Albemarle Sound bottom. There will be some short-term turbidity during piling installation. Kimberly Hedrick — 25 March 2013 ®CM Project Narrative MAR 2 5 209 I am Robbie Hopkins, contractor for Robert and Jeannine Saunders, property located at 95 Cypress Shores Rd ext (off SR 1319), Cypress Shores Subdivision near Roper in Washington County and adjacent to Albemarle Sound. CAMA General Permit No. 60979 B was issued on Nov 26, 2012 for the replacement of an 88'x6' pier and 20'x16' L -head platform, partially covered with an additional 18sf roof overhang and replacement of 20'x6' finger pier to an existing uncovered boat lift. The structure has 2 existing uncovered lifts each 12'x12' in size. All work has been complete with the construction of a concrete pier structure as authorized by the aforementioned General Permit. I am proposing the addition of a 16.5'x6' step -down to the existing 348 sf L -head platform, for a total of 447sf single component shaded impact. I am also proposing 2 tie pilings off step -down for creation of wet slip (3`d slip for structure). This will provide for easy water access for swimming and boating, kayaking etc. The proposed step -down and existing platform and finger pier will result in a total of 567 sf shaded impact and the property has a +- 450 linear feet of shoreline on the Albemarle sound. Robbie Hopkins Marine Construction �WAS*Irlfflffiow (�ni►.Q �qw.w c�tr.�) WFUCITIBNbr 081WIMINNOWPOMN (last reweed 1?lZ' IN) North Carolina DIVISION OF COASTAL MANAGEMENT 1. Pilmary Applicant/ Landowner lnftnmdon Business Name Project Name (if aWlcabie) Irv- Applicant 1: First MI last Name /Name (+ S G" S AWficard 2 First Name MI Last Name MaDing Address � & 110Z r G e(S Naddltional appkents, please attach an addldonel pages) with names listed. Malting Address PO Box CRY State S FAX No. Contractor # ZIP Country Phone No. FAX No. CR 7� v SOT amt. - - Street Address (if dWerent hum above) City State ZIP Email 2. AgerttlCo Wacilor Inkn6adon Business Name H22PKI A S kwk" AP- Agentf Contractor : First Name 4nv6�- MI Last Name �1 - Agent/ Contractor 2 First Name MI Last Name MaDing Address � & 110Z r PO Box It—, I V nV( f ZIP xg")D Phone No.1 31�94t- 93SW Phone No. 2 - - ext. FAX No. Contractor # Street Address (if di ierent hom above) City State ZIP Emall <Fonn continues on back> Form UUM MV -1 (t-age Z Oi 4) �arruv+u�•- Major Development Pin 4. Sloe Gescr�ptl6n County (can be multiple) Street Address State Rd g rJ BSc ss shoct.s 131 SubctvNlon Na city e ZIP C ess Shtx� o Qr Zc .. - X?'70 P"N . Lot No.(s) (it marry, attach adddiond page with ft Q' (Attach zoNng caMbnce ceref ale, N applIuMs) ❑Yes ONo a. In which NC river basin is the project located? b. Name of body of water nearest to proposed project ff yes, by whom? 4 c. Is the waterbidy Identified in (b) above, natural or manmade? d. Name the closest major water body to the proposed ProJed she. Natural OManmade ❑Unlarown e. Is proposed work within cdy limits or planning )<uisdicdon? f. If applicable, Ibt the planning )un'sdidion or city limit the proposed Oyes ONo work fags withh. L-L-� stir au 4. Sloe Gescr�ptl6n a. Total length of shoreline on the tract (IL) b. Size of entire trad (sq.fL) �( � C7 S-� c. Size of Individual Iota) N%J+ d. Approximate el of tract above NHW (normet hfgh wafer) or NWL (rrormaf water1eyeq P— (f many lot ske� please adMand page with a Est) ONHW or NWL e. Vegetation on tom, e- "Kxwq LL) i 'tkA S(���c�•�. tY�i-� �� 4'reeS �r� f. Man -made features and � U`�•h�� � �rO,n3 � � F��"- s -�•tv� ��t,�`� � 1 � -�+`,� g. Identify and describe the existing land uses to the proposed project site. MNaeACr 7v,,_ <Sr�jnr_e S�1o�•� ►s��rt- (bw cl-o > wr v*6eQel o(�� 10 rJ1 h. How does local government zone the bidO t. Is the proposed project consistent wiM the apptka We zoning? (Attach zoNng caMbnce ceref ale, N applIuMs) ❑Yes ONo J. is the proposed activity Part of an urban waterfront redevelopment proposal? OYes P- Has a professional archaeologW assessment been done for the bad? If yes, attach a copy. OYes o ❑NA ff yes, by whom? I. is the proposed project located In a National Registered Historic MsMct or does it involve a OYes PWo ❑NA National Register fisted or eligible Property? Oonn continues on next page> Form DCM MP-1 (Page 3 of 4) APPUCATION for Major Development Permit m. (I) Are there wetlands on the site? Mee PNo (1) Are there coastal wetlands on the site? (]Yes*o (11J) If yes to either () or (11) above, has a delineation been conducted? OYeslo (Attach documentation, if avaDable) / n. Describe existing wastewater treatment facilities. 'Af bn-w -- �v.�<-'Sc�S�ew� o. Describe existing ddnidrig water supply source. I C) Sr �C— WQJ" p. Describe existing storm water management or treatment systems. r10 n � S. Acdti O" and Impacts a. Will the project be for commercial, public, or private use? ❑commercial ❑Public/Govemment 91�dvate/communay b. Give a brief description of purpose, use, and dally operations of the protect when emmplete. PUrpo - a S S+'Coclore- �G� WgitC r 01\ C'- .J, -}r'eS c. Describe proposedpasW cordon nrettwdology, types of construction equipment to be used during won, the number of each type of equipment and where it Is to be stored. 1, , .4 /,4,,,44 . J'O �.. -he� prct�' tuC.'Vv %, IA t�x3 �` =sly �' Cucbr�►,�� n d. List all development activities you propose. . 5 X (o r ec j of o (V o e *I $�I� P`Q <— 141 S�A�';254 v-R2krf'r\ -P-0 r Cl� 4q 7 Lom(so i ' L S (�la ,r,r� a�- cQ p 111 nab �Or 3rd � 5'' , L e. Are the proposed activities maintenance of an existing project, new work, f. What Is the approximate total disturbed land area resulting from the proposed project? JSSq.R or ❑Acres g. Wig the proposed project encroach on any public easement, public acceasway or other area KYes ❑No ❑NA that the public has established use of? h. Describe location and type of existing and proposed discharges to waters of the state. I. Will wastewater or stormwater be discharged Into a wetland? OYes ❑NA If yes, will this discharged water be of the same sdWty as the receiving water? Oyes ❑No ❑NA J. Is there any mitigation proposed? 17Yes To ONA If yes. attach a mitigation proposal Oonn continues on bads r-Orm U%,M mr- r trays 4 ui 11) Major Development Permit 6 Addltlonal IRliamadon In mkWm to this completed, app<l OM Anm� (UP-1) the 1b6gtnrl�g 6�=""A, O., be_tsilbfp yl�r'- ,gpp��on P4~ fo be complete. A -f9 ere always a � � J er' bnsEruc6ori boaw on bow to POP* prepare fie na� Oms.O loYv: a. A project narrative. b. An accurate, dated work plat (Including plan view and cross-sectional drawings) drawn to scale. Please give the present status of the proposed project. Is any portion already complete? If previously authorized work dearly indicate on maps, plats, drawings to disiing*h between work completed and proposed. c. A site or location nap that Is suf iclently detailed to guide agency personnel unfamiliar with the area to the 9119. d. A copy of the deed (with state application only) or other instrument under which the applicant claims title to the affected properties. e. The appropriate application fee. Check or money order made payable to DENR. L A list of the names and complete addresses of the adjacent waterfront (rfparlan) landowners and signed return receipts as proof that such owners have received a copy of the application and plats by owned mail. Such landowners must be advised that they have 30 days In which to submit comments on the proposed project to the Division of Coastal Management. Name t'�ver %� ! Phmre Nq. Address O ago -a7q ?a Name Phone No. Address tr>e aloeC'� �Q`�q `°'r +��'ti1Q u f� Phone No. Aftess �� t�a, Cal�,kn g. A list of previous state or federal permits issued for work on the project tract. Include permit numbers, permittee, and Isa ft dates. 11 /able h. Signed consultant or agent authorization torn, K applicable. 1. Weiland deffneatfon, ff necessary. N J. A signed AEC hazard notice for projects hi oceanfront and irdet areas. (Must be signed by property owned k. A statement of compliance with the N.C. Environmental Policy Act (N.C.G.S.113A 1 -10), U necessary. If the kwolves e)Wdlture of public funds or use of public lam, attach a statement documenting compliance with the North Carolina Environmental Policy Act. U T a► On# ABRi?1�Sign t0 El-11 . on l js111d r I understand that any permit issued in response to this application will allow only the development described in the application. The project will be subject to the conditions and restrictions contained to the permit I cefiy that I am authorized to grant, and do in fact grant permission to representatives of state and federal review agencies to enter an the aforementioned lands in connection with evaluating information related to this permit application and follow -up monitoring of the project. I further certify that the information provided in this application is truthful to the best of my knowledge. Dom Print Name jPobe ir+ t°f Signature Please indicate application attachments pertaining to your proposed project ODCM MP-2 Excavation and Fitt Infomtation ODCM MP-5 Bridges and Culverts ODCM MP-3 Upland Development p6CM MP-4 Structures Information — - - - - - -- - - - - - - - -- -- - - -- - -- - - - -- Folrm DCM MP-4 - - - STRUCTURES (Construction within Public Trust Areas) Attach this form to Joint Application for CAMA Major Permit, Form DCM MP -1. Be sure to complete all other sections of the Joint Application that relate to this proposed project. Please include all supplemental information. 1. DOCKING FACILITY/MARINA CHARACTERISTICS a. (i) Is the docking facility /marina: ❑Commercial ❑PublicIGovemment W4ate/Community c. (i) Dock(s) and/or pier(s) ofe„ (i) Number ` (iii) Length (iv) Width (v) Floating []Yes []No e. (i) Are Platforms included? eyes []No If yes: (ii) Number (iii) Length (iv) Width (v) Floating ❑Yes []No Note: Roofed areas are calculated from dripline dimensions. g. (i) ,umber of slips proposed (ii) Number of slips existing i. Check the proposed type of siting: ❑ Land cut and access channel []Open water, dredging for basin and/or channel 0Open water, no dredging required ❑Other, please describe: 1 k. Typical boat length: m. (i) Will the facility have tie pilings? @res []No (ii) If yes number of tie pilings? 2- ❑This section not applicable b. (i) Will the facility be open to the general public? ❑Yes 5° d. () Are Finger Piers included? []Yes 0wo If yes: (i) Number (ii) Length (iv) Width (v) Floating - []Yes ❑No f. (i) Are Boatlifts included? []Yes 090 If yes: (ii) Number (ii) Length (iv) Width h. Check all the types of services to be provided. ❑ Full service, including travel lift and/or rail, repair or maintenance service ❑ Dockage, fuel, and marine supplies eDodkage ("wet slips) only, number of slips: 1 ❑ Dry storage; number of boats: ❑ Boat ramp(s); number of boat ramps: ❑ Other, please describe: j. Describe the typical boats to be served (e.g., open runabout, charter boats, sad boats, mixed types). z open 1-'OvA1Cot- 1. (1) Will the facility be open to the general public? []Yes ❑W = �;�..�.�•ri. �K�3 ., +- 3�C0���":: �i�.v.°�ca �asa.�ia�ars�ue�ac� „�3�� r:��i��sti: � r1�"I'��� • Form, Inc MP-4 Pass 2 of 43 Z. DOCKING FACIUTYAWARINA OPERATIONS &ibis section riot appfcable a. Check each of the following sanitary facilities that will be included in the proposed project. ❑ Office Toilets ❑ Toilets for patrons; Number. ; Location: ❑ Showers ❑ Boatholding tank pumpout; Give type and location: b. Describe treatment type and disposal location for all sanitary wastewater. c. Describe the disposal of solid waste, fish offal and trash. d. How will overboard discharge of sewage from boats be controlled? e. (i) Give the location and number of 'No Sewage Discharge" signs proposed. (ii) Give the location and number of " Pumpout Available° signs proposed. f. Describe the special design, if applicable, for containing industrial type pollutants, such as paint, sandblasting waste and petroleum products. g. Where will residue from vessel maintenance be disposed of? h. Give the number of channel markers and 'No Wake' signs proposed. L Give the location of fuel- handling facilities, and describe the safety measures planned to protect area water quality. j. What will be the marina policy on overnight and live- aboard dockage? k. Describe design measures that promote boat basin flushing? I. If this project is an expansion of an existing marina, what types of services are currently provided? , m. Is the marina/docking facility proposed within a primary or secondary nursery area? ❑Yes []No 4- 983.1R:3A1.3`r �ba.sad; 12:27195 n. Is the madna/docking facility proposed within or adjacent to any shellfish harvesting area? Yes • PN� •e _t. ... . , t. s •� •. ', o. Is the marina/docking facility proposed within or adjacent to coastal wetiandshnarsh (CW), submerged i (SB), or other wetlands (WL)? If any boxes are checked, provide the number of square feet affected. ❑CW ❑SAV ❑SB ❑WL�^ ❑None p. Is the proposed marina/docking facility located within or within close proximity to any shellfish leases? []Yes ❑No If yes, give the name and address of the leaseholder(s), and give the proximity to the lease. 3. BOATHOUSE (including covered lifts) a. () Is the boathouse structure(s): []Commercial ❑PublictGovemment ❑Private/Community (ii) Number (ii) Length (iv) Width Note: Roofed areas are calculated from dripline dimensions. (SAV), shell bottom section not applicable 4' . GROIN (e.g., wood, sheetpile, etc If a rock groin, use MP -2, Excavation and Fill.) LMis section not applicable a. (i) Number (i) Length (iii) Width 15. BREAKWATER (e.g., wood, sheetpile, etc.) , 6This sectioptrotgpplicable I i a. Length b. Average distance from NM, NWL, or wetlands c. Maximum distance beyond NHW, NWL orwetlands S. MOORING PILINGS and 'BUOYS . `, 's sgo�ion nqt applicable a. Is the structure(s): ❑Commercial ❑Public/Govemment ❑Prhrate/Commumty C. Distance to be placed beyond shoreline Note: This should be measured from marsh edge, if present e. Arc of the swing 7. GENERAL b. Number d. Description of buoy (color, inscription, size, anchor, etc.) - �'�- ,�3�F3 -:�:i . '- 3�z�d:����t:�a'�3 i �vv :nW.rA��� %�iatr���ts���x.dyc�i ^�w3:s.2 <a..; !•?h:S�e3 • a. Proximity of structure(s) to adjacent riparian property lines b. VProximity of structure(s) to adjacent docking facilities vol e Note: For buoy or mooring piling, use am of swing including length of vessel. c. Width of water tidy �H ,7 rri,. e. () Will navigatio at aids be required as a result of the project? ❑Yes !o' ❑NA (i) If yes, explain what type and how they will be implemented. d. Water depth at waterward end of structure at NLW q 18. OTHER ►is section riot applicable a. Give complete description: i Applicant Signature 52- i3Sy2iSfsS .. ^. -3:88 -4—LAC 3Aw7 . - :,I :m��: � r ?," ;35 } V'3 p Lv M � � , Ha • X A d d f c r 60 40 M i Q 3,9 Q ct ©t , �z a A F y da ` d + -- - 4d J d u �r d Cross sa--Yt oej dRI S4ep d oo0) lQober� a J�cnn;� SgJndie.�s Ctoatyt, Sho <�Sp5tl1 c: v;,j oN Cross Sect; cr V Q ?rc paste Robert and Jeannine Saunders 95 Cypress Shores Road East (off SR 1319) Cypress Shores Subdivision in Washington County CAMA Major Permit Site Map of Property (2013) Vkk , 3125 11.3 t-A-'1� N 39' 38' 37' irn 36' 4711 *35' � 3a ZJoins Chart 6 � - ' I " 29' `� 28 �Ij 27' f' Snag PA °Pile 1V11 - 12 t YE i— 7 11 �i ._49 _�. 19 lr 7 Z: lei, 5��Su64 Rep i3 3 1116 32 13 1 16 i7 � E t s "IKC'Fl c e ROU % 4 I 5/ 13 + YEAn n01l I f �/'Z '� 130 Foul-4 ra�„=, akes ep 4 4 u 3' St SUIIrtn'�s" N C Fishing License Required 2 � --' u ary pox. 3 HD PWR CAB Skinn v1Be '� 6 KEY' UTH CL 49 FT 11C1fI8r --M Beach 1 1$18 — ---- - - - - - -- 1323 HOR CFIXED BRi GE - L ERT CL Fr 308 1136 _ ` \ �� 130 OVHD L pt nt G ve — — L9FT E� - 08 Be, cley - _ m 2 eo ° \ \1\ a a 1111111111111 11111111111 to 64 1 3 3 113 /.; 13 9 \ \\�\\ \\ / / /j� / 130 1301 t' y fv' o ul' n ���� NOT lyr * '--- - o � e - `" ���dunlunbm I \ ; 1 ndgn /p —K NBR1@K•DEPTH M CKE EK „ r�' "/ TT CR WAS 1a Fr lu E 1977 1135 9°` b�`\� o`�•��M�� / �� ''' \� e° j S ppernong 1331` ., 113 Ck reek 133 _ = 071 — s ROPER a — _ = loo INC EAS 00 'w _ = = a- (1 3 114 112 O r;7 G ;r T7 F r, t 42. Authorized Agent Consent Agreement I,� S�j �, hereby authorize ; „ r _ ` to act on IL (Property Owner) (Authoriib. Agent) my behalf in obtaining CAMA permits for the location listed below. This agency authorization is limited to the specific activities described above. Property Address: f �►1 _�.A:a Cam. ,.I Property Owner's Mailing Address and Phone Number: Property Owner's Signature: zw:�, Authorized Agent Signature: Date; ,UT IA Form: Authorized Agent Agreement as developed by NCDCM revised 7/29/09