Bishop, Matthew

1 CAMA / ❑ DREDGE 8t FILL
NO. 75071
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 "%
1
110 (J
and the Coastal Resources Commis I
n"
n in an area of nviro mental
concern pursuant to 15A NCAC {
Rules Attached.
Applicant Name t E "�'
<"+�' � �/-i'
!/mac)_( 1
Project Location: County f)
/
Address
Street Address/ State/Road/ #(s)
City = 1 f r. State //" ZIP
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jLot
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Phone #
Authorized Agent
Affected ECW 9EW .©PTA
AEC(s): OOEA ❑HHF ❑IH
❑ PWS:
ORW: yes / no �` PNA yes / no
Type of roject/�A(ctivity
/ ✓`
Pier
Fixe
Floa
Fing
Groff
Bulk
Basil
Boat
Boat
Beac
Otht
Shor
SAV:
Mor
Phot
Waiv
DES, ❑ PTS
❑ UBA ❑ WA
City1 ',-)
Phone# O
Adj. Wtr. Bodyk
Closest Maj. Wtr. Body—
ZIP
(Scale: )
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yes
A building permit may be required by
( Note Local Planning jurisdicti ..�"
�yotes/ Special Conditions P 4 C '
Alrl5
Permit
read compliance statement on back of permit'**'
❑ see of on back regardin River Basin rules.
4j!' PlicAiod"Feels) Check# Issuing 7

SDI ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to MAVI-LOU).. W blSHb P s
V (Name of Property Owner)
+Jtproperty located at 1 �-6 -SoA),) L- 4Ao PS- SwAtacR to G a85�r'f
*\\v (Address, Lot, Block, Road, etc.)
\�on ZDSRs ')bp&�A -,in swans&Cb 1 O PSLs per N.C.
y -1 (Waterbody) (Cit owin and/or Coun
.('f3 The apOicant has described to me, as shown below, the development proposed at the above
Cgs�� Ioc 'on.
1 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 d s¢ription below or attach a site drawing)
tH
y
J
IUD
I � 5 �
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.)
c wish to waive the 15' setback requirement.
N ITIAL �j I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
A
Sur
thiprITREw &S41&
Print or Type Name
/�6 Soap ,e {lop�rr Ra
Mailing Address
C� zFsa
City at
Tele hone Number qt6 72e4 32475-
6/-l' lqi
Date
4G,13,lel
Date
5
(Revised 611812012)

s
/�6✓ ��s-I�fle. ����
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to
I'D", �J property located at ) A4 --SO4A L � o
` Address,
tnD�S`I in
(Waterbody)
The applican as described to me, as shown
r location.
/Z,3 — S 9 5"--2
's
Zb4� N.C.
County)
below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
IX CA Al
P
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 cjo wish to waive the 15' setback requirement.
" I do not wish to waive the 15' setback requirement.
(Property Owner Information) ( scent Property Owner Information)
Sigiiat re
1~1
Date
G .2g<SIS
r v-'?,95-
or
;Revised 6/1812012)

a < Z
CD
0

AQFNT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Offl `GEj )�f 416 kv4
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary
for the following proposed development: J—)t
i1 C tAc
at my property located at ©k vL yo?P
in ltslo c.J County.
l 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.
Property Owner Information:
1
" Signat
Print or Type Name
Title
ZZ t Zol�
Date
This certification is valid through / 0 / 01 / 2c/!'
A-Lm QHw.W0Q
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