HomeMy WebLinkAbout20240057 Ver 1_Site Plan_20240108Proposed
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North Carolina Department of Environmental Quality I Division of Water Resources
D- I E Q3, 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000
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Lake
(At Full Pond/ Normal Water Levey
Existing Dock
30ftx7ft
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3ftx150If
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Below full pond/ NWL
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Above full pond/ NWL j
Plan View
North Carolina Department of Environmental Quality (Division of Water Resources
K,J 512 North Salisbury Street ( 1617 Mail Service Center i Raleigh, North Carolina 27699-1617
a.rr 919.707.9000
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO.
Lis
A L I � �
PLAN NO. t>(r' S`b4 PARCEL ID: 74
STREET ADDRESS' i , LJ 7 IgIt2 '
0 (Ak),c- &t L4 N G , 27 30
Please print:
Property Owner: NZc'�3 1 tj PC,4> L-i
Property Owner: (:) IA- Mt' W -5. G coo P f-CZ
The undersigned, registered property owners of the above noted property, do hereby authorize
i 1,4-)t V-tGGt eI'T— `5 of AN6K0 R1410
(Contractor / 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):
7011 &-( tD DUST (,-V4ui , ,rej0i*rj-rrZ'Ac.L-, NC) 2�a7q
Telephone: -Jd 1 " 3u 3 _ G l Z3
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: l L�� 1 OL-D 2-3
Authorized Signature
Date: "T- J