20231013 Ver 1_More Info Received_20231109 (2)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION

Name of Property Owner Requesting Permit: _________________________________

Mailing Address: ______________________________________________

______________________________________________

Ph o n e N u m b e r : ______________________________________________

E m a il A d dr e ss : ______________________________________________

I certify that I have authorized _____________________________________________,
Agent / Contractor

to act on my behalf, for the purpose of applying for and obtaining all CAMA permits

necessary for the following proposed development: ___________________________

at my property located at _________________________________________________,

in ________________County.

I furthermore certify that I 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:

____________________________________
Signature

____________________________________
Print or Type Name

____________________________________
Title

______/_______/________
Date

This certification is valid through ______/_______/________

5036 WITTERING DRIVE
COLUMBIA, SC 29206
James (Jim) Graham AIA
Renovation and addition to existing
single family residence.
509 Harbor Drive, New Bern, NC 28560
Craven
06 26 2024
CATHERINE H. CLARK, TRUSTEE
[e-mail]
803-360-8038