Lemon, Jean

LiiCAMA / LL DREDGE & FILL No. 73114 A B C D
GENERAL PERMIT Previous permit#
JNew ❑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 Commission in an area of environmental concern pursuant to I SA NCAC
-❑ Vies attached.
Applicant Name Project Location: County
Address Street Address/ State Road/ Lot #(s)
City
Phone # ( )_
Authorized Agent
Affected ❑ CW
AEC(s): oOEA
❑ PWs:
ORW: yes / no
State ZIP
E-Mail
❑EW ❑PTA El ES ❑PTS
❑HHF ❑N JUBA ❑N/A
PNA yes / no
Subdivision
City / ' ZIP
Phone # ( ) River Basin
Adj. Wtr. Body nat. man unkn
Closest Maj. Wtr. Body CPt U�Ar✓
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)_
Groin length
number
.Shoreline
Length
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■III■■II■■■■■■■
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■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit**
Permit0(fcer's Printed Name
Signature
Application Fee(s)
Check #
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Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: l kGry]
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
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(2527 9 3Q -- i IZS
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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 oZ b I .T
in Car+CM—L County.
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1 furthermore certify that l 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.
Properrttyi Owner Information:
Signature
' j e-an I-}, Le i'Y nY
Print or Type Name
Title
Date
This certification is valid through
RECEIVED
AUG 0 7 Z019
DCM-MHD CITY

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Sao
'Foi)f- PAMP
s e
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$ RepLYee ���k li"X /,,,�SCef
RECEIVED
AUG 0 7 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to ' 1Par l 's
property located at j�(
o 1 Jean'4 J (Name of Property Owner)
F, A� � (Address, Lot, Block, Road, etc.
on �11�Pt tAA in FtG(Y l�D I'C I N.C.
(Waterbody) j (CitylTown andlor 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 ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
):)DG'l(, rt- lG c fVQ-n�5�—�04 a&CtiolV4
—
WAIVER SECTION
1 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.)
zI do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
i L L-
EA
'Valid for one calendar year after signature'
Property Owner Information)
I
Date" - RECEIVED
(Revised Aug. 20144), G 7 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 3FX-4-I L.0 MOtJS 's
(Name of Property Owner)
property located at 20N '�Fn1n11�C� b21JE
W ESTM ouTN �y (Address, Lot, Block, Road, etc.)
on r`'w in
1-1/a2KF2i iS>Gulp
(Waterbody) (City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
Cam_ 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)
4-r: rAc%1Ep'
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.)
C DK I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
i
g lahu:e
P4o
Print or Tvoe Name
[date
email address
`Valid for one calendar year after signature`
(Ad' enk Property Owner Information)
71
Sid ure
0 0112 LF.-i J YAt.C-
Print or Type Name
SO Dy I4QFe- P-Ol1D
Mailing Address
WiN{tcgngyI SC 2-g180
Citylstatelzip
21)3-17-0-3c�1�
Telephone Numberl email address
I RECEIVED
Date n
(RevisedAu%6g1W17 Zp)g
DCM-MHD CITY