Town of Morehead City

^ L CAMA / ❑ DREDGE & FILL No. 75040 A B I C D
GENERAL PERMIT X Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Datepreviouspermit issued
�IAs authorized by the State of North Carolina, Department of Environmental Quality I .
and the Coastal Resources Commission in an area of environmental concern. pursuant to 15A NCAC
_ Rules attached
Applicant Name. i� (" �" i' �� (/ Project Location: Countylk-
Address Street Address/ State Road/ Lot #(s)
City- _ State ZIP ( /
Phone # ( ). _ _ E-Mail
Authorized Agent
Affected ElCW ❑EW ❑PTA ES ❑PTS
AEC(s): OOEA F1 HHF LIH ❑UBA ❑N/A
F1 PWS:
ORW: yes / no PNA yes / no
Phone # (, )
Adj. Wtr. Body
Closest Maj. Wtr. Body
\ 1
-/ ZIP
{fiver Basin
(nat /man /unkn)
MOMS
Im
-
III I pahm
0
reline Length 0
mul 1110 IN oil
ME 0 MER
M
I
'Ors IV alum
notsure yes no
M
ver Attached: es
■
I
111>
1
111/1/
■ilwl
.G■il
■■
■■■
■■■.1■nl"�
■■■:N■■■■■■■■■■Ill■■■■■■■■■■■■Y■■■®�
■li�
■1■1:.'NIE►!L1®C�llNit�®��
'�IM✓1�11''lli■■
■■■■■■
■■■
■ii■■■w!1■wL11r;R9�1.!■
u
rt�■■:IG..:i..■...i...
■■it►■Null■r■!N■IiWr�vl■1►�-ii-ii�Irl�Irl�G�■Ir!■■■■■■■■■■■■■
I�r.mr�■
Nl.l�l■�u■m�xl
■■■:■
■1■■■I■■�■■
NiY■
Agent or Applicant Printed Name
Signature "Please read C 0ancestaiement on back of permit"
Check#
Permit0(ficer's Printed Blame
Signature`
Issuing Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: i0Wt'1 D� moy-E'Hcnb C' TT`/
Mailing Address: 9 0(o )q Qkj-Ap)GL.L1 ST
Phone Number: ap-,la1.- a?')L4 ?-')
Email Address:
I certify that I have authorized DENNIS & SONS MARINE CONSTRUCTION, LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: -�015 &d-AQ5 3 P LFEF-
=NSTRLLf�TIOfJ J7= GI' ol= VIIQYL_ iRaU"AL0.,b
at my property located at
In CARTERET
County.
/ 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
Print or Type Name
YS'D(�tLr
Title
Date
RECEIVED
This certification is valid through 12 / 31 / 2019 JUL 0 2 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ti 0'r MOCI;IIG11 D C iT i 's
(Name of Property Owner)
property located at ,tyi6 F VANS 3 i k'_,CCJ"
(Address, Lot, Block, Road, etc.)
on 13oUuE LOO A C_> —,in c�1C�w".t�c"r-�n GT f C_4-12-c�ETN.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca n.
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, 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) (Ag"cent Property Owner Information)
Signature
'l(x�:IJ �'F laal('-i?At�IF�LL`iLL/IblS
print or Type Name
Date
q
email address
DECEIVED
(Revised Ad!I2644 2019
*Valid for one calendar year after signature*
0CPJI-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to ` —12-OtJ OF QOWV( 19 D C EL 's
(Name of Property Owner)
property located at V�ti`"
(Addre
on
(Waterbody)
ss, Lot, Block, Road, etc.)
in MORA--I-\E-00 0-VX V OPI Tl Q 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)
j t� S �U.AT( bfJ a F (01' O F 'B U.A- L4�-tA o
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
1 oc< C�E - 'DAt-MrL W11�1,tt M6
Print or Type Name
Mailing Address
I-'n t-+c tJC_ QFyEr=>J
City/StatelZip
Telephone Number/email address
Date
Property Owner Information)
Print or Type Name
ICI J)&Lp; Z0 Ji' 1V �
Mailing Address
QC' 2?53y
City/State/Zip
Telephone Number/email address
IRECEIVFD
Date*
*Valid for one calendar year after signature`
(Revised AJU . "4019
I)CM-MHD CITY