Conner, Mattie

^ CAMA / DREDGE & FILL NO. 75215 A g C / D
L
®GENERAL PERMIT Previous permit#
C
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 pvironmental concern pursuant to I SA NCAC
❑Ru�fsattached.
Applicant Name (( jf All L- r Project Location: County ¢'f '
Address If ce r �/4 Ne, Street Add ess/ State Roft Lot #(s)
City f�'I r State�.Y ZIP. % V�� I �'t'�j: ��✓"
Phone # (_ ') '` t E-Mail Subdivision
Authorized Agent / // ' City / zip,
t
Affected L)CW ''EW &KTA ❑ES ❑PT5 Phone# ( ) River Basin
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC s() : ❑ PWS: Gn
Adj. Wtr. Body',:' i at /man unkn)
t 1
ORW: yes / Closest Maj. Wtr. Body
-
Type J PNA yes /- no �
Type of Project ]
s/ Activity 1 / r` f -� 1 t
Pier (dock) length
Fixed Platform(s)
Floating Platforms)
Finger pier(s)
Groin length
number
Bulkhead/Riprap length
avg distance offshore
max distance offshor
Basin, channel
cubic yards
Boat ramp
Boathous oatlif X/
L '
Beach Bulldozing
Other
Shoreline Length v
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes _ no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
�Tjr c K C. \-tJ c�
Ager,t or Applicant Printed Name
(Scale: 1✓7 ) )
See note on back regarding River Basin rules.
Permit Omcer's Pr' t d Name
Fee(s)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: I t o �l i e gL�C�✓1 I���(�
Mailing Address: /3%P �[ �Q 5�✓1 I I �id� b� _ /✓�'
-�I'A,A6Lu-o 0 C-�1�BJ��
Phone Number:�1
Email Address:
I certify that I have authorized (T a`r ca'I 1 Dkd o C
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining
all CAMA permits //
necessary for the following proposed development: 7e15fa// a L� r F
IO C-A-
,
at my property located at /3% P��aSGYG?>t S1/c��C lid(
in 0rxJCf-e `I' County.
I furthermore certify that 1 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
Print or Type Name
O Wd1`e�
/ Title
Date
This certification is valid through /a- 13 f lI q

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to / ot 41 e� ti s
11 'g / (Name Property Owner)
property located at_i3 h(CG+ SaW r VV oa)� o
(Address, Lot, Block Road, etc.)
on �Ax"Ic cgorr. P"de in 6Gtr%Pr2� � N.C.
(Waterbody) (CIty/T own and/ County)
The applicant has described to me, as shown below, the development proposed at the above
to 'o
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
U
�G
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.
�do not wish to waive the 15' setback requirement.
(Property Owner Information)
1d1 d•-ls(�S 1 ad'
Telephone Number/email address
*Valid for one calendar year after signature*
( 'acent Property Owner Information)
Signal re" /
avj' �l2idNPGL
Print or Type Name
&&2/ Lake
"'� �Addr#sse
cryisr?C19 q&a^ 7100
Telephone N m er/email address
.7 1
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to e �aw or 's
(Name of Property Owner)
property located at_/ l / (iPGi5Gtb1 T Aioe� Aw
jj�))I n Address, Lot, Block, oa , etc
j
on W k a P;leC in �Olr ir-P CG✓4 N.C.
(Waterbody) (Cityff own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
�AI
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 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.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/Statelzip
Telephone Number/email address
'Valid for one calendar year after signature"
(Adjace t Property Owner Information)
Si ratur� '6 �dK
(Revised Aug. 2014)