Hughes, John

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CAMA / C DREDGE & FILL No. 73455
-r 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 f�
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
'• �r Ruyes attached.
Applicant Name �n /i Q Q S Project Location: County �c �t-� ('
Phone #
Authorized Agent
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Affected
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n PWS:
ORW:
yes / no
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(yes / no
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Subdivision 11
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Phone # ORiver Basin �Gt SC'�
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Agent r'Applicant rime anie
Signatur 't• Please read compliance statement on back of permit"
Application Fee(s) Check #
PermitOffcer's Printed Name
Signatu e
IssuincDate Expirati. n Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
133
I hereby certify that I own property adjacent to _ %�3 -S',C WA y /- /VSS Z) Q. 's
(Name of roperty Owner)
property located at 13 3 S /� �' +� y L4 (f s-S (] ci.
(Address, Lot, Block, Road, etc.)
on SgKb 1 Muss G2_,in CA2-r&-f-g-T N.C.
( at�lll erbody) (City/Town 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 fill in description below or attach a site 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner
—d /BU6-1-I[�s
Print or Type Name
/3J SA'd�.b Y HlrsJ a Z
Mailing Address '
i3 L-jf* v (=0 cz•=y
City/State/Zip
.;, —
Telephone Number
G �,
Date
Property Owner Information)
T 1 hon umber
0ate
<2- i
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 13 / S Fro✓b s /-fVss ') ri. 's
(Name of Property Owner)
property located at - / a 3 A, y / fyss D 2
on S ✓fi�'�Y f4uss r- in
(Waterbody)
Block,
G Fr 2 , N.C.
(City/Town 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 fill in description below or attach a site drawing)
(11-0 anQ rrr4.t-"-
F - /da / .-V-
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 Owner Information) (cent Property Owner Information)
- -k
S ature Si naturre l l
d fib ��/ GHcFs �AnGiEL �495�c
Print or Type Name
131 sra�D� FFVss �sZ.
Mailing Address
City/State/Zip
s - 7 aS-�
Telephone Number
a /� Af-
Date
Print or Type Name
Z/
Mailing Ad/dress
hVL,�- AZ IV
City/Stater ilf
54-� - 9Z4V
Telephoneummer
Cv// Z// �U
Date
(Revised 611812012)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ev U & 14 L s
Mailing Address: / 3 / S'.4 W :D y v s.r I ,?—
Phone Number:
Email Address: �h 1 a s �l 3 G A y e a s, C c' n-
certify that I have authorized cr
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: R i (4(� j9 (Nil y
H �Y N/a ✓tr c N
as rr v
at my property located at 13 1 -5.7 a f /.f s s s b rz, -
in 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
Title
dGl dr 1 a6I'J--
Date
This certification is valid through