Roberts, Ken Jr.

L
WCAMA/ O'bREDGE & FILL No 71633
GENERAL PERMIT Previous permit# A B C °
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 7/
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC � r
�! IVRules attached.
Applicant Name //Il (1 � `. t� � ( Jf "' Project Location: County__
Address t/ ` � C 0& ? Street Address/ State Road/ Lot #(s)
City AA i Y7E �- to StateAj/^ ZIP 'I
Phone # (/" 72/VF_Mail
Authorized Agent
Affected ❑CW DEW �k PTA
AEC(s): EJ OEA ❑ HHF ❑ IH
❑ PWS:
ORW: yes / no PNA yes /!no'
r"
Subdivision l
City _ ZIP
❑ES ❑PTS Phone# O River Basin
❑UBA ❑N/A Adj. Wtr. Body _ _ _ inat /man' /unkn
Closest Maj. Wtr. Body ---
SEE
Agent or Applicadt Printed Name
_.'�� J.
Sigpa`t:ure*�a+'Plepsetreadcomphancestatementonbackof-permm��
Application Fee(s) Check #
Permit Officer's Printed jJame 7
Signaty re
IssuingDate Expiratfon Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: %n
Mailing Address: Y'
NG 2b51o[7
Phone Number: �Ko- 32D - t4 Fr I
Email Address: rb b�_- rn \ f' h Do 1-0 rr--%
I certify that I have authorized Of I G
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Lneja`o b p4J
at my property located at 1 309 Dr MeO &—M flf-
in Craye-r County.
/ 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:
�.a_ 9=�s
nn S1ig ature
Print or Type Name
rx� V\-O—C
Title
(.O /18'
Date
This certification is valid through / 2 l 3 / 201 V

Description and Drawing of Proposed Work
Property Owner:
Section Number: - Lot Number: Z39 a
Owners Name: Kex-� I b b \eri S1
Address: 1309 Ce ne_c�_re- ­0 ✓ Nae,7 F �r(� i�L zaJ`bD
Telephone Number: E2 D` 3 2 c)- U 18 1
E-mail Address: V_robe rot t r-rn �� a• LDry
Contractor:
Company Name: C�r�G T Abe Jr. Cbt1S�TYJG�I<7Y�
Contact Person: CxA-_C--
Address: 135 e i, c- I�Gq r'
Telephone Number: 2. 5 2. - % 2 <J - li %'Ta
E-mail Address: A Y-t rtia n Pn _g• `� (I l elm
Detailed description of proposed work:
d i�rc,.F irT-,a2V.e�� bo 40 `t5 Lu , tJ�i 1� F Q�C.LMJ✓v, �`�r „ D
(u he r�rwtred Dr n �l�e site �v� %nee 40
��� Ci f a Ehertia 40 CV �N ✓
"To -scale" drawing of proposed work:
2 4t
v_
Q_ w
Q
l30
4,
0
0
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 1�rn d- 2O �aar"1 s
Address of Property: 13D11 czxxc C Yb---'D /- gec31�r r\ K. c ,DB Lf)6
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
en -, I LtL <\r
l bn6+fc l of) Mailing Address:
/ 35 PA,� PP 4
Agent's phone #:
262 - 7 26
- tl 7-1 D `6e-ow
�4 (—
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. c1 ed
I/ 1 have no objections to this proposal. I have objections to this proposal.
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
available at http://www.nccoastalmana_qement.netlweb/cm/staff-listinq or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
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.)
—4--t'r— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
een (J,--)hoer45
Print or Type Name
13D�I Gct�ar� ✓« 17 ✓
Mailing Address
mew (3errl NL 2 35�D
City/State/Zip
$2E -,gZo - 617,51 /Xroher t- )r-rn 90
Telephone Number /E ail Address V*V-M. LLYM
6 -& -ot la'
Date
Information)
Print or Type Name — / `
Mailing.Address
City/State/Zip
_ r
Telephone Number/Email A4 ress
c/ t�C o
Date
(Revised Aug. 2014)

Description and Drawing of Proposed Work
Property Owner:
Section Number: ,`") Lot Number:
Owners Name:
Address:
Telephone Number: a L• 3/� C
E-mail Address: �D f'(
Contractor:
y
Company Name: ( r. <Lc. ^(l`i1T�.LC" I+
Contact Person:
Address: I � IC:
Telephone Number: �. ` ; . / / <l " I - j
E-mail Address: r '-i r cC r Uc.: ., L- 1
t: v
Detailed description of proposed work:
r l..-C 2:)Ci. v'iC C'.. ,�)
-,1. �\ti LCC:.0
t.-
_ •�
L Y C-L-C.
�
i:I r1P. ��ivtC`Lrcc.L -t rC'r-�, `t ;_c
nr
"To -scale" drawing of proposed work:
?' -^"• t_�
2 tL
V ..
0— LL
Q

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Tracking Number: 7017 1070 0000 8538 3895
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https://pts-2.tisps.gov/pts2-wcb/tclntranef l'rackiiigN iiml2esponse/dcliverySignatureAndAd... 5/25/2018

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 1Y� d- J Lt -e Rob n ri f)
Address of Property: 13V-1 CCrac�r�. 7r j11-1W T 1-0 NL �g�(e(]
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
6-1c-j ca.'tc. Jf. CUN! t[M
'MMailing Address: 135
12d
Agent's phone #:
2.52 - "726 - 47 9 D
�Bea-tXor 4
SL
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 drawino, with dimensions, must be provided with this letter.4��ct
V I have no objections to this proposal. I have objections to this proposal.
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
available at http://www. nccoastalmanagement.net/web/cm/staff-listinq or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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.)
TQr I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
1 Erg =J Z/ G� �a 1 G✓///9 P/ �Vir O /�7l It%z
Signature Signature
1�fn obc-r-t� MM y /-yNNG 16L75- l d /Vo
Print or Type Name Print or Type Name
13aq C�r�cG.r� 7i ,�
MAA11ailing Address
1 (�ct iy 1-L-2,56(oo
City/State/Zip
S)F - 320 . N7nl I�robcrFs r_n OP
Telephone Number/Email Address lJ,ahoo•(am
5 - G -,)-0 1 (-
Date
/aA' Z4A)7-cX11' C�ye
MailinqqA g 9� ddress
City/State/Zip
Te ephone Number/Email Address
Date
(Revised Aug. 2014)

Description and Drawing of Proposed Work
Property Owner:
Section Number: _,17,5 Lot Number:
Owners Name: i4: r
7 L
1
Address: !'6()`1 e,
Telephone Number: -'! i bi
E-mail Address: IfY 0
Contractor:
Company Name: (_;T C LLL C - J ,)I
Contact Person: t-
Address: j -3
Telephone Number; 41
E-mail Address:
Y 1 -A
C
Detailed description of proposed work:
A
r
rc
CL.0 C,
ty
L r-
"To -scale" drawing of proposed work:
� V—

s
`— .ress on the reverse
,is card to you.
,e back the mailplece,
ace permits.
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Service
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2. AKicle Niam' rn,,.."•'" `-"- ,I ❑ Signature Confinoation
7�17 1070 000❑ 8538 3888 Restricted Delivery Restricted Delivery
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PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
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