Flora, Lynn

Al
�I'AMA / ❑DREDGE & FILL No 71644 A B D
CNERAL PERMIT Previous permit#
Nev ❑Modif cation ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resourc s Commission n Area of environmental concern pursuant to I SA NCAC v
(J / ❑ Rules attached.
Applicant Name N %A'- ' `-, Project Location: County /
Address t v f C k Street Address/ State Road/ Lot #(s)
Cic.1
ty s i r G / Stag ZIP
Phone #� !_M/yit Subdivision
/ l r/U(�r ZIP
Authorized Agent (� City �(l�
ElCW 29W .P,PTA ❑ES ElPTS Phone # ( ) Riv r Basin
Affected El ❑ IH ❑ UBA ❑ N/A <:. e.,,, �-
AEC(s): OEA Adj. Wtr. Body I � - � " " '. at man /unkn)
❑ PWS: _ _ a .n
Agent or Applicant Printed Name
Siu�p ** Please read compliance statement onback o(permit
**
Application Fee(s) Check #
Permit0(fiCer's rinsed Name ^---^-----.._,_
Signat ,Date
Issuin Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1y,�0 F /Ora
Mailing Address: _�-32.Cj 4p�otZ-p,/ a
Phone Number:
Email Address: 6%? 6"Ora &a Xolzk-r "l e o
I certify that I have authorized 1)ta_\jh jj fZj _ry , I FT X�)�c L,
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:
at my property located at K-t. t`z ST I S s
in Cr., ,k CU k) 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:
.t
Signature
ZY L"2 % Flom
Print or Type Name
lJ t'Aiy% eY
771116
7 l /.�3 l /gr
Date
This certification is valid through

AWMENT RIPARIAN PROPERTY QWNER STATEMENT
I hereby certify that 1 own property adjacent to-L-JZ e I1) f yci Z el IV ilt)
property located at —Al l q S T' I "A
Owner)
(Address, Lot, Block, Road' etc.)
on in
(Waterbody) (CityfTown 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) l4
yIIAJVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
e I do wish to waive the 16 setback requirement.
1 do not wish to waive the 1 & setback requirement,
(Property Owner information) (Adjacent Property Owner Information)
' ��&l tict zc I (,^AOYNA 1
Dwe
z <+lot th h'"ct Z 1 i . Gynn flora
or Type Name
! I - 6 LM ST
M a>C,Z) , dc- .)R%f
tom
U
"Valid for one C81an far year after Ogriature- (Ravised Aurg. 2014)

Aug 01 18 Q4:42p Dudley's Marina Inc. 2523932380 p.1
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: L-\-I I. )" F. F L eA
Address of Property, -
(Lot or Street #, Street
Agent's Name #:
Agent's phone #
Road, City & County)
Mailing Address:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
W.
If you have objections to what is being proposed, you must notify, the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is ;
availableathttp://www.nccoastalmanaoementnet/web/cm/staff-list'noorbycatiing1888-4RCOAST, r
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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
L-,q0 J � rll)��I
Pnnt or Type Name
432q WtR1,N �z
Mai-�ling Address
Crty/State/Zip
Telephone Number/Email Address cc°^
q(2sli�
Date
(RiZ
roperty wne I ton)
Si aline
Print or Type Name
n
Mailing Address
CrtyJState2ip 9 a9 � r t1C ZyS?A-
elephonh Number/Email Address
A() III
Dater
(Revised Aug. 2014)

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