Babin, Brian (2)

I LAMA / ❑ DREDGE & FILL 2 No. 73427 A B C D
® EMERAL PERMIT Previous permit#
New ' ❑Modification ❑Complete Reissue
❑Partial Reissue Date previous permit issued
As authAized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an are of en ironmental concern pursuant to 15A NCAC (✓(
) -/ ules attached.
Applicant Name 1 Project Locatiort County 1 4 �hI t( __
Addres 711 Street Address/ State Road/ Lot #(s)
City ' _ State
Phone#LVI` _. ) _Mail r
Subdivision
Authorized Agent )/
( f
City/1,&,t1
D Cw ❑ EW
❑ PTA AS ❑ PTS
Phone # (�N
Affected
AEC(s): ❑OFA ❑HHF
I 1H ❑UBA ❑N/A
Adj. Wtr. Body--),
❑ PWS:
Closest Maj. Wtr.
ORW: yes / no PNA
yes /.no
Type of Project/ Activity
q i
)) t ,( 1" i
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number -
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel ----
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes - no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: eyes no
A building permit may required
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature sa Please read compliance statement on backof permit's'*
❑ See
on back
ZIP _ Y
Basin
(Scale
River Basin rules.
Application Fee(s) Check #

I ryA4) 6AAL"l
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit -
Mailing Address:
Phone Number: - 1 t�
O4 — a `2 ((,7
Email Address: A`33 I tj J k4aT cyR t L_ eo (V�
I certify that I have authorized l �rS .j sOfis
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1,%41c, "
at my property located at _
in Car-l-ref 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:
rk
Signature
Print or Type Name
Title
Ik
Date
RECEIVED
This certification is valid through I /
JAN 3 0 201.9
0CM-UHD C,,,

I hereby certify that I own property adjacent to 's
(h(ame of Pr%prty Owner)
property located at �U l lNCJ l < Ls/Z k-
(Address, Lot, Bloc Road, etc.)
on , inN.C.
(Waterbody) (Citylrown and/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 rill in description below or attach a site drawing)
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 td 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 Owner Information) (Adja, ant Property rwner Information)
,Signature -
Print or Tvoe Name
){oI lgr[
.Wh
1-`
Date*
RFCE(v;�D
® JAN 3 P019
cM-Myp CITY
(Revised Aug. 2014)
`Valid for one calendar year after signature'

charles wray
.Jan 11, 2019 at 4:41:44 PM
[e-mail]
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WAIVER gECT10N , or gt nr,
breakwater, Yxoa.khou"'
,
understand that a pier, dock, mooring pflings, boat ramp. 15' from MY area of riparian access unless v etved C 1
must be set back a minimum distance o must initial lhe appeopriate blank tt i
me. (If YOU wish to waive the setback, y
I do wish to waive the 15. setback requirement.
_ 1 do not wish to waive the 15' setback requirement_ Property Oei to�ai or
�t
owner lnforrnation
{Property--•-'-�L�
SignatUre
Sia�zfrt4'��F {�� /� ! /1 try` i Print or Type blame
1.
Print o T NNP
a e J e $ rt �7ry Mailing Address D�7J
1 �r�foCl�,, �—
rY7 ��n�yyg��A,,d � S � .
k(1/e a f Cam- I 1' ate2ild
"Valid for one
CITY

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