Benton, Jeffery

N
�1 CAMA / ❑ DREDGE & FILL
UENERAL PERMIT
� gW ❑Modification ❑Complete Reissue ❑Partial Reissue
No 71683 A B C D
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Qualityf: tt
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 7
❑ ules attached.
Applicant Name J < j r �^ "ram, Project Location: County �HJ 0 L
Address (�uy1. i' Street Address/ State Road/ Lot ,
�(s)
City r"^ l (_ Stat zIP �)&n —1 . ` 5 l l f c "
L y
Phone # (Lj 11, ` / O � E-Mail Subdivi(s(jon �} {
Authorized Agent �� e�f I City _i 1,'1 " zip Jt 0
ElCW
qEW UPPIA El ES ❑PTS
Phone# ( ) River Basin
Affected
AEC(s):
❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ WA
Adj. Wtr. Body t I �' ✓���'at man unkn
❑ PWS
ORW:
yes / no
PNA ye�/ no
Closest Mal. Wtr. Body_
Type of Project/ Activity
191
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.
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ME—
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Agent or Applicant Printed Name
;.
Sign I I •�' Please read compliance statement on back of permit
o�_ Utz
p licaton Fee(s) Check#
Issuing
rr
Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: c)f�`� i
Mailing Address: 5DS tj SERE :cK.
51.ttftr�iSBDR�� NG Z�SY��
Phone Number: q! D 322 -'{aa3
Email Address: a a Q11,CL — t
I certify that I have authorized Oe.
Agent/ ntractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: LZ �k a 1,
at my property located at SOS w S� DRI SWMS6DiQQ,, NC
in [.NSt_o ti/ 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:
Title
6 l/ Y l /0
Date
This certification is valid through l 7 1 l

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
s
I hereby certifythat I own property adjacent to
(Name of Property Owner)
property located at SV 5 w j l-fmE
(Address,
on >y44-K/NS ('REJQt in,
(Waterbody)
etc.)
N.C.
— (CitylTown ancuor _uu­Yi
t roposed at the above
The applicant has described to me, as shown below, the developmenp
lopation.
X lw 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)
5 atta4edQ S14-e- aci�w,' %.
WAIVES TION
lift, or groin
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse,
must be set back a minimum distance f 15'from my area of riparian must initial the appropriate blank belss unless waived by
me. (If you wish to waive the setback, You
X�I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Property Owner
Address
Valid for one calendar year after signature`
email
(Revised Aug. 2014)
Ma

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to FfF.P/ A f3ErJ iZ� j — 5
�-^ (Name of Property Owner)
property located at 7 0' w SIDE fib? — — ---
(Address, Lot, 7, Road, etc.)
on 14&A)t=1'i A —02ak in _ — IIwcl :!&0? 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 desceiON i1' )� ? �
See 41(6 .tree 51-fe Gi(Y ins .
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.
x I do not wish to waive the 15' setback requirement.
Dare
'Valid for one calendar year after signature'
(Adjacent Property Owner Informs lon)
(" � h{� . _
Signolnf 11
1,
n pQfId14
Dore'
address J tea(
(Revised Aug. 2014)

I
ADJ CENT RIPARIAN PROPERTY OWNER cTATEMEN7
.Ify that 1 own Property adjacent to
's
/,(ocated at joS IJ $HgpF aq ( erne of Property Owner)
(Address. 1 nt Ri....1.
�r
CIN 7-
ILIN
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GoMaps
August 17, 2018 1:1,128
0 0.0075 0.015 0.03 mi
0.015 0.03 0.06 km
2018