20230084 Ver 2_Jowers, Brian - Agent Authorization_20230406

Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: Y
Email Address:
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necessary for the following proposed development: 1A -t" -� )) ", .� )­(,c., f \./ L.
at my property located at
in l -County.
/ furthermore certify that / 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.
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17
Print or Type Name
Title
2-
Date
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