Aman Powell, Cynthia

AMA / DREDGE & FILL NO. 75952
GENERAL ❑ PERMIT Previous permit#
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eW ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �% L/ / /G
and the Coastal Resources Comm. lion in an ar of enviro ental c n rn pursuant to I SA NCAC / /
r f ❑Rule attached.
Applicant Name /� r ` r i, r Project Location: County (.,^, '`, - `
Address
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City
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State A)r ZIP'-
Phone #Mail
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Authorized Agent
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Affected
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Affecte
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❑IH ❑UBA ❑N/A
❑ PWS:
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yes/rnol PNA
yes/no J
Street Address/ State Road/ Lot #(s) /
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City � "-dr, ZIP
Phone # ( ) RiveryBasir
Adj. Wtr. Body
Closest Maj. Wtr. Body—
ME
Agent or Applicant Printed Name
Sign Lire lease read compliance statement on back of permit"
*
plication Fee(s) Check #

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I Pa. NCDENR
(� by Nolth Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor James H, Gregson, Director William G. Ross Jr., Secretary
Date or/ /7 /9
Applicant,Name 2 /tA`ixt8: 1—�RAIA-i DIyE l i
Mailing Address �E LN5d 04L O—C-
I certify that l: have authorized (agent) //��1C1.,w to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) NNw
at (location) �� 1 ll�LtC �i7� _(���1�1 UU��✓C11� C
This certification is valid thru (date) 4/, // 24
Signature
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400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.nA.Lla OHIN-IND(I
An Equal Opporl unity \ Affirmative Aclion Employer - 50% aecyc!eo \ 10%Post Consumer Paper 6107 8 1 A ON
03AI3098
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ADJACENT RIPARIAN PROPERTY OWNER ,/ STATEMENT
I hereby certify that I own property adjacent to �u�1 1Titi A I m4YJ RuK �� 's
0 (game Rf Pfoperf� Owner)
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property located at a 6t,v„ Qa d i LF�A-2 r.JoiN �-
on �� iy , in CPS n 2 of { N.C.
(Waterbody) (City/Town arid/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 rill in description below or attach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
K 6� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
LI-
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
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Mailing Address
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City/statelzip >
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Telephone Number tU
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(Revised 611812012)
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I hereby certify that I own property adjacent to /.+ ilYh&n1 bye' 's ,
�D` ,I �r (Name of Property Owner)
property located at 6 I�XAat Wt hJJ
(Address, Lot, Block
(Citylfown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati n,_
I have no objection to this proposal.
I
I have objections to this proposal_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
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WAIVER SECTION
1 understand that a pier, dock, mooring pilings, 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.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(property Owner Intormauonn)
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Sign tzrre (� �D���I
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Prior taror 7-e /1f1
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Telephone Number
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(Adjacent roperty n nformation)
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