Wright, Michael

[qCAMA / ❑ DREDGE & FILL
GENERAL PERMIT Previous permit#
0New ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of `North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area o(environmental concern pursuant to I SA NCAC
1 i ❑ Rules attached.
Applicant Name Project Location: County
Address 1 ; , / Street Address/ State Road/ Lot #(s)
City y' ( 1. State2�ZIP �) I )i I . _-
Phone# ' ,
(') '�'
I , 1'l
`.E-Mail
Authorized Agent
Affected 0cw ❑EW O'PTA ❑ES ❑PTS
AEC(s): ❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /, no
PNA yes / no i
Subdivision
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City r '�.(,! .; l ; / ZIP
Phone #�filver Basin l
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Agent or Applicant Printed Name
Signature rr Please read compliance statement on balk of permit"
Application Fee(s) Check
PermitOfcer's Printed Name
Signature
Issuing Date Expiration Date

F GEEN " AUTP,'9RIZATION FOR CAMA I13ERMIT APPLICA'TIOI
Name of Pro:ielty Owner (Requesting Permit: A
c.0 `
Mailing Addn oss:
PhoneNumbi!r: „La —3�a_
Email Address;: y`4hw—,� Co
I certify that I hate 3uth xi;::ed Q V^
Arlen Contractor
to act on my hehalf for the purpose of applying for and obtaining all CAMA p !rmiitts/
necessary for tho fo llowing proposed development: i �r e, Lt j— Z�
at m pr perfi, located at
in` —County.
l furthermore (,e;tifj that l am authorized to grant, end do in fact grant pe mission to
Division of Cc asi al )Oanage°ment staff, the Local Pem:iit Officer and their age is to enter
on the aforenrertio�ted lands in connection with eveduating information reh `ed to this
permit applica'ioi I.
Property Owner
Prii it c, Tipe hlanie
Date
titre
L --IF
This certificatic n i 3 valid Ihrough
RECEIVED
APR 192018
DCM-MHD CITY
At,

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to y , lmz I LT I Is
(Name roperO r)
property located at 7G(s � ��
(Address, Lot, Block, Road, tc.)
on in t , N.C.
(Waterbody) (City/Town and/or County)
he 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.
(Individual
V
4
AND/OR DRAWING OF PROPOSED DEVELOPMENT
alopment must fill in description below or att ch a site drawing)
rru j
WAIVER SECTION
I understand hat a pier dock, mooring pilings, breakwater, boathouse, lift, or groin ust be set
back a mini um 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.)
Date
wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
r or
09
Telephone Nu e/f Y PR 19�01�
Date
n^
p CITY
(Revised sz,� 4y

� L�!
7)
!,Fit
z IJ
1517
IRECEIVED
APR 192018
DCM-MHD CITY
00\

ADJACENT RIPARIAN PROPERn OWNERS -ATEMENT
I hereby cer fy :hat I own property adjacent to
(Name Prope y C.VY r)
propert loc tecIat_ Ct
{ ddress, Lot, E lock, Road, .) tc
one —, in _��:T-CE -- N.C.
Waterbody) (City/Tovm and/or COIL nty)
The applice .t has described to me, ;:is shown below the development p-op )se d at the above
locatio .
I have no objection to t -iis proposal.
I have objections to thi;> proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELCDRIVIE NT
(Individual 1*,posing devetopmene must fill in des cription below or aO"ach i it site dr�wing)
�t
N
r
r 0 J
L :r
,I I WAIVER SECTION
understar I that pier, dock, mooring pilings, breakwater, boathouse, lift, or
back a min num distance of 15' from my area of riparian access unless ar<a
wish to wai a the. setback, you must initial the appro xiate blank .tektw.)
I do wish to waive the 1 !i setback i'equir:ment.
(� I do not vfish to waive the 15' setback requirement.
1V (Property i wner Infgtmation) (Iidj t Property
r
t ttre� Lei
l l7" - ✓ l _
Pri r Typ erve
'o t�
Mai WAdd
Telephone t umbej�r
�/�
— =—[_ �. —
Date
oin must be set
I by me. (If you
S gnatur
e7
P ant o Type Name ` C
lVailing %ddress
C ity/State/Zip — O
Telephone Nuroer W as p
Date 0
(Revised 611812012)

RECEIVED
APR 19 2018
rs .. -