McLamb, William (2)

CAMA / ElDREDGE & FILL ;y, , ^ No. 73982
A B <C D
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 Commission in an area of environmental concern pursuant to 15A NCAC
❑ules attached.
Applicant Name �' ' ' r, ^'! >h �E/( _> Project Location: County
Address '>� �> i r r Street Address/ State Road/ Lot #fS) % / ,
i.
City �\ r',� Stater�� ZIP 71 J(
Phone # OBE -Mail /
Authorized Agent
Affected ❑.CW ElEW ( TAP El ES ❑PTS
AEC(s): ooEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PNA yes / no
Agent or Applicant Printed Name
City % � ` f` / >
ZIP
i
Phone # O� River Basin l
Adj. Wtr. Body %/` lr" %(nat /man /unkn)
Closest Maj. Wtr. Body
Signature ** Please read compliance statement onback ofpermit
Application Fee(s)
Check#
Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date :? - / —, 7
Name of Property Owner Applying for Permit:
Mailing Address:
v 3 GJ. v
0�a (e�
I certify that I have authorized (agent) X1J /�l�"� - &W (e !�Ko act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date) 2
Property Owner Signature
✓ — P—
Date
RECEIVED
MAR 13 Z019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
_ c
I hereby certify that I own property adjacent to r h,6 14mJ is
c (Na of Proper nerd
property located at C uc t
� (Address, t, BI ck, oa t .)
on 1GlG i">u.�L in CP C.
( ate4errbody) -(CityTTohh andlo County)
The applicant has described to me, as shown below, the development proposed at the above
loc on.
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 sits drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 laich to waive the 15' setback rer, 6mment.
I do not wish to waive the 15' setback requirement.
(Property Ow Information) (Adjacent Property Owner Information)
ti
LGt+�ia a 'e. T C l (�i S (On rrW
ipnolur2 Signature
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Print or Tvpe Name' , . Print or
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Rrt�r:�U�t IVL
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ity/SJ, t512
City/State/Zip
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Telephone Number
Telephone Number
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Date
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(Revised 611812012)

I hereby certify that I own property adjacent to
pro
on
Cl
IP
The applicant has described to me, as shown below, the development proposed at the above
location.
x- I have no objection to this proposal.
have objections to this -proposal. -- ___ _ _-
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing ofeveiopmenf must fill hi uescriptiun below or a.tach a site dra:vhr gi
WAIVER SECTION -
I understand that a pier, dock, mooring pilings, 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.
(Property
V
Print or Type Name
U?13 WiNttt+.�i' DP..
Mailing Address
f-k1.E,Ceff, N(-
City/state/Zip
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Telephone Number
4i'7-i� /A
Date
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scent Property Owner Information)
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P." /'1. - e ILLS C14 Q
or Type ame W o 2
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tg Address U
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Date -31z Z//q
/ (Revised 611812012)

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