20230822 Ver 1_Hubbard Auth Agent Form_CAMA_signed_20230608

DocuSign Envelope ID: 1FF047E8-96C1-44D2-A571-A6646D2F646D
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Michael Hubbard
Mailing Address: 1807 Chester Rd.
Raleigh NC 27608
Phone Number: 919-255-0411
Email Address: [e-mail]
certify that I have authorized Anthony& Sylvan
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: in-ground pool + patio
at my property located at ,
in Wake 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.
Property Owner Information:
DocuSigned by:
i.ZGG.3.3C0G1CGOh
Signature
Michael Hubbard
Print or Type Name
Title
6/1/2023
Date
This certification is valid through Of/01/202 4/