20240588 Ver 1_More Info Received_20240604 (4)

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO: Tract F-3 PLAN: Riprap & New Dock Constr PARCEL ID: 2755 20 5916
STREET ADDRESS:
1385 Dry Ponds Rd
rr— a G,n� rur )Atizn
Please print:
Property Owner: Christopher Gwyn Kelley
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Yvette Huffman
(Permit Agent)
of Lake Permit Services, LLC
(Name of consulting firm)
to act on my behalf for the processing and submission of this permit or certification.
Property Owners Address (if different than property above):
Mailinq) 4421 Calico Rd
Lenoir NC 28645
Telephone: [phone] [e-mail]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Mure
l
Date
JA
La Per ilt Services LLC
^Date