20231644 Ver 1_Site Plan_20231206

T `0
Proposed
(Plan View
Lake
(At Full Pond/ Normal Water Level)
66-as-T two- OW.&
woo
Full Pond/ Norma !Na b' 4zP 7 to do '
HM OM am no am M
Shorelinevv�v��`�i�J
Lake
North Carolina Department of Environmental Quality i Division Water Resources
512 North Salisbury Street 11617 Mail Service Center !Raleigh,, North Carolina 27699-161.7
919.707.9000
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Proposed
(Sid ew)
4'
t
Lake Ofz
(At Full PondNormal Wa er v I` C)
01
CL
I' � C
to
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street ! 1617 Mail Service Center i Raleigh, North Carolina 27699-1617
919.707.9000

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
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LOT NO. PLAN NO. 'PG- LJ 5i9 PARCEL ID:
STREET ADDRESS: I I I b0 G-.j D o 0 (-IA- i
McAt,rT ��c.4. , NC , Z7'2--,o6
Please print: � k r, tj ���C- Z-
Property Owner:
Property Owner: �- oer �A �' �`� �� 4A—
The undersigned, registered property owners of the above noted property, do hereby authorize
AL4 Y- f2l Lf�L�TTS , of k/j-NCL 00-CLz 0eL-->t L-M
(Contractor J Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: 611 q
Su'5 I n ZQ
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Auth razed Si ure Authorized Signature
Date: Z 20 _ Date: )1 j Z Z Z 0 7,3