Get ENG 4345 2018-2022
E a. Residence c. Fax b. Business c. Fax STATEMENT OF AUTHORIZATION 11. I hereby authorize, to act in my behalf as my agent in the processing of this application and to furnish, upon request, supplemental information in support of this permit application. SIGNATURE OF APPLICANT DATE NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY 12. PROJECT NAME OR TITLE (see instructions) 14. PROJECT STREET ADDRESS (if applicable) 13. NAME OF WATERBODY, IF KNOWN (if applicable) Address 15. LOCA.
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