Martens, Harry

fCAMA / ❑ DREDGE & FILL
"GENERAL PERMIT
ew ❑Modification ❑Complete Reissue ❑Partial Reissue
f✓ No. 73460
A B ( LC—) D
Previous permit #
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 ' l/. /
ules attached
Applicant Name Ri `V A"I I fi cn
Address �7 k,,,,tf
�
City ( n, J� I (% r i 1 State ZIP
Phone # ( r) . !� ;� (/ r �� E-Mail
Authorized Agent
Affected LICW „NEW PTA [I Es' ❑PTS
AEC(s): ❑OEA ❑HHF ❑IH ❑USA ❑N/A
❑ PWS:
ORW: yes / no PNA yes / no
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision I '/ i y' � / e r ('
ZIP
Phone# O RiverBasinff �vN_-r r_
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Agent Applicant Printed Name -
Signature "' Please read compliance statement on back of permit*"
Application Fee(s) Check #

Harry C. Martens
397 Starboard Drive
Oriental, NC 25571
hcm2630Qgmaitcom
Home: [phone]
Cell:[phone]

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
d/1
Agent / contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: IY0,41I=y A0C/
i / y r-7-- <
at my property located at
in /^ G G 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:
Sighature
lint or Type !Name
(2"el"
Title
2c
Date
This certification is valid through /�' l 3e / Zd/

Customer Contact Information
Date: 21 ( 3 1.Zc)r I
Name:
745-1
Phone #: / Z - / ' 7 d/ / �/ �52�
Street Address of the Subject Property (or location):
Town and County:
(mod
E-mail (Optional):
In Reference To (Please provide a brief description, such as "Need a permit for a dock.
Ae,'�,f-� k7 0 /off

I hereby certify that I own property adjacent to
property located at
on rr�ua��c In
(Waterbody)
etg.)
L , N.C.
n 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 ANWOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill lrl description below or attach a site drawing)
ZIT
1
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
(Property Owner
Ci,alure'
CF1 A aZl S r=, W A Ll`��ZLi
j� Pri t or Type Alamo
Mailing Address
V t azGt nlsrFii� � (��1�3 �f 5(0
City/statea ail atldress Tele h ne Number/email address
(Revised Aug. 2014)
'Valid for one calendar year after signature`

Begin forwarded message:
�+ �8 Oraamail com>
rry Martens
5ubJectadock relocation �—
pate: February 12, 2019 at 6:66:16 AM EST
To; iku2oxtinllum net
I hereby Certd3l that 1 own ProPe.^.y adJBCent t0 r
property located at (Address, Lot, E
on (Waterbody)
The appiicam has described to me, as shown bo'ow
local) I Have no objection to this proposal.
Is
N.0
the development proposed at the above
_ I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
// k 6 // % V
xv t.rC t �r �.�6 - fO///
y i till
i
.73
' WAIVE_ iCT[Q"S
I understand that a pier dock, mooring p+lings twat tamp bfeaKwator. boathouse lift or groin
must be set back a minimum) distance of f 5' from my area of riparian access unless waved by
me. (If ycu wish to waiva the setback, yot: must initial the appropriate blank below )
1 do wish to waiva I" i 5' setback requirement
� X t do not ,ish to waive; tho t5' sotbaC): requirorrOnt.
iPropatty Owner Infer ration)
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