20230757 Ver 1_BARKLEY_20230731

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT No. Aq S PLAN NO. �~ PARCEL ID: 3-6 7 3 I- t,
STREET AI]DftE55: ql�;- _�G�
J-4 Dti+►or ► >W 1
Plea— pant:
Property owner: t u.ur•
The undersdaned, registered property owners r:f the above noW property, do hereby authorize
L vkw- tl',-t l r z- c-e-
[Contractor 1 Agent] (Name of consulting firm)
to act an my behalf and take all actions necessary for the processing, issuance and acceptance of
Oft permit or c&tfxation and any and all standard and special conditions atUKhed.
Property Owner's Addirm (if drffererit than property above):
VV4L-
T6ephone:-7 ] .
We hereby terry the above information subm.tted in this application is true and accurate to the
best of our knowledge.
u riz awre Authorized�Signature
carte: 1 Date.

Full annrl i
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Please spprnxlrrmatsly sketch the fvilowing inform *ton on this plan jPn vd* d1m'I�u;0ns for
fm, such us to ft Jr 100 ft f *:
All proposed vegetation clearing
LIcatlon of rip rep or fill to be plate above the Full Pond/'Normal Water Level elevation
3. Location of rtp rap or fill to be piaad below the Full Pond/ Norn-al Water Level elevation
4. Location cf any proposed structures such as bulldinga, retalning walls, docks, etc.
5• LOcatlon of any axcavatlon or dredging below the Full Pond) Normal Water Level elevation
b• Location of construction accass corridors
FORM: S%P I0-2DI3
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