Mariners Point POA

j�CAMA / ®'DREDGE & FILL t✓ No. 73305
�. A B C D
GENERAL PERMIT Previous permit#
NNew ❑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 % �� r �'
� ules a ached.
Applicant Name _ Project Location: County `i E. 4, i _lace
l
Address
Phone # ( ) t l(: i
Authorized Agent
State ZIP
E-Mail
Affected O CW , EI EW d PTA El ES ElPTS
A
Affecte �OEA ❑HHF ❑IH ❑UBA ❑WA
❑ PWS:
CIRW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length -
Fixed Platform(s)
Floating Platform(s) _
Finger pier(s)
Groin length
number
Bulkhead/ Nprap length
avg distance offshore_
Basin; channel �' :'W '�4
cubic yards
Boat ramp
Boathouse/ Boadift
Beach Bulldozing r
Other
i
Shoreline Length
SAV: not sure yes A�l
Street Address/ State Road/ Lot #(s) l ' j /1 i '
Subdivision
City
Phone # ( 1
1
ZIP
River Basin
i. .!
Adj. Wtr. Body - _ - (nat'-/man /unkn)
Closest Maj. Wtr. Body --
u
i
(Scale:
Moratorium: n/a yes no I I t
Photos: yei no
Waiver Attached: ye no
A building permit may be wired by: ! 7 I l..[.> to ! ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
1 �100 l t,i' P r,
Notes/ Special Conditions It ) j - "x C i' f-iY
Agentor Applicant, Printed Name /
Signature 'Please read compliance statement on back of permit"
Application Fee(s) Check #
l JC�
PermitOfficer's Printed Name
Signatuf e q
1131o%5
Issui g Da a ExpiratKn Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to MQfine s Vnir)A C'Qod OmiN tam 's
Name of Property Owner)
property located at t O t 0 1 a6)kx Qq� M 9a VRf pafilr1 NC ass la
(Address, Lot, Block, Road, etc.)
on , in r O'rFer .r QIAahA N.C.
(Waterbody) (City/Town and/oO County)
The applica t has described to me, as shown below, the development proposed at the above
locatio .
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 wa' a 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 Ow////jjjjjj������er Information)
�A7
(QgzTlure'
orah Holcurd
Print or Type Name
C30x �I ISS
Mailing Address
1 rn(Irr�ICl Isle, ryC )SSq`I
City/State/Zip
QSa- 354-io333
Telephone Number
a-11-1°I
Date
(Adjacent Property Owner Information)
,L= a /---
Signature n
Print or Type Name
976 saH -Ir,H, Z
Mailing Address
3atf�aE� NL 2flS7S-
City/State/Zip
25z-yzz-IgSS
Telephone Number
2 -//— / `i
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Ma6oerS Ppy)t 0.nAdfYY)i'lilJ1n 's
(Name of Property Owner)
property located at 1 Ot n Nxi 000d LSnlW Pares-, roc a S51a
(Address, Lot, Block, Road, etc.)
on , in (n( re.j (OiAoD4 , N.C.
(Waterbody) (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.
(P perty O er Infor ation)
Mture
rnh HQ1.k)QrA
Print or Type Name
Pn cy H9SS
cling Addr ss
«►off ►pie Nc assyN
City/StatelLip
a -39H �3.»
Telephone Number
00.1-01-doI°I
r I'm
(Adjacent Property Owner Information)
City/State/Zip
Telephone N ber
�-air
Date O Z \
(Revid ll, /2012)