Hoffman, Pearl

-1CAMA / O DREDGE & FILL �/ (fY f c /1 No. 75933
GENERAL PERMIT Previous permit#
-New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources mmission in an ar a of environmental concern pursuant to I SA NCAC / '
% r ❑�ules attached.
Applicant Name ' 101 �Project Location: County ��� r�
Address o� �� ( i "r"y G Street Address/ State Road/ Lot #(s) /
City S of( �' State /U� ZIP .t / A I t '
Phone # () 0 %) .S' /U- E-Mail Subdivision(
Authorized Agent 1 P r �J� "� S City J (r'" /
ElCW &EW 61PiA ❑ ES ❑ PTS Phone # ( ) River
Affected OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A 4 .emu
AEC(s): ❑ P S: Adj. Wtr. Body#
ORW: rfv PNA yes / no Closest Mal. Wtr. Body
Type of Project/ Activity t 9 5 1 / /;/
Pier ('__,_. ___.1
Fixec
Float
Finge
Groh
Bulks
Basin
Boat
Boatl
Beac
OthE
Shon
SAV,
Mor.
Phot
waiv
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Silture^ e• Please read compliance statement on back of permit'""'
Application Fee(s) Check #
Permit Officer's
Issuing
ZIP
r
(Scale: ,,t7p )
[J See note on back regarding River Basin rules.

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: /}�tfrl %+• ��m`"`
Mailing Address: / C/3 c/ C
ii5helbrv, ,t .C. a�
Phone Number: 33(y 9�53 - 930
Email Address: fl/� auto t e„ k/
I certify that I have authorized Bey"M cm EFW 6 ,
Aqent / 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 L983 Bee, A l- C- 284/(r,
in (- r e e+ 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
/�C/-/ A/
Print or Type Name
Title
Date
RECEIVED
This certification is valid through / / NOV 13 2019
DCM-MHD CITY

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 1 � r-/ f+-
Address of Property: o J , " ' s l v1 rl , -/W 1:;� •
/(Lot or Street #, Street or Road. City 8, County)
Agent's Name#: �/vf�e 6ik�5 MaitingAddress: 12&.v6ks Gz
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawl the development
they are roposing. A dikU tilts=teast.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what Is being proposed, you must notfly Me Division of Coastal Management
(DCM) In writing within 10 days of receipt of this notice. Contact Information for DCM offices Is
aveliabie at httoJAvww.nccoastaimenaaementnet/weblctWstaNd)stino orby calling 1-888 4RCOAST.
No response is considered the some as no objection If you have been notMed by CerWed Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of riparian access unless waived by me. (If
you wish to waive the setback, you must Initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the IS' setback requirement.
(Property Owner Information)
ignature �7
-�nir-I P. 1�01 fw�at
Print or Type Name
(Riparla)t-property,gwner In[ormatlon)
Signaayt��ure hh A/
Ptint or Type Name
ly3yC1�FF f -7� C c
Malling Address Malting Address
3 36-553-9-?o 3 &aa S'2 361
Telephone Number/E ell Add kw"1, Go,,i Telephone Number/Email Address
1140-0 il:Lgx� / z ,2-61 y
Date Date
(Revised Aug. 2014)
RECEIVED
NOV 13 2U19
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to PC-or)I 's
n / (Name, of Property Owner)
property located at ag3 Sfm; f5 f�i✓1 �1�c� � �v
(Address, Lot, Block, Road, etc.) /
on S � � i t`� � t�1/ail' 1 in &ritj `f, /V.C/r f'is/ of , N.C.
(Waterbody) (City/Town an/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop rty Owner Information) (Adjacent Property wner Information)
stgJr�rll l�o, w- sZg�Cl I�A�/j5 Print or Type Name Prnnt ypANalrie j l
Ig3q(1, '�( o�in U
Maili g Address M�illnked�drVess) I %�C ��'Sil
%shP{kr�{f�(C.iz%173 (( jj
City/state/Z' 1 City/state/Zip
3 - 3 C)3 > 52 -:Aq 541 J f�uUislcs�
Telephone Number/em it address Tele hone Number/email address RECEIVE[?
Date Date*
(Revised Aug.WV4j 3 2019
*Valid for one calendar year after signature*
,�^AA_nn�lf3 CITY
0.

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44m
RECL..;Er),
NOV . 1019
I)CM-MK ^ TY