Annie M. Piner Family LTD

❑DREDGE & FILL " No. 74925 A B C D
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As autho zed by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
) n Rules attached
i l I 1✓:
Applicant Name ' i I ✓ project Location: County _
Address i o _ __ i . _ Street Address/ State Road/ Lot #(s)
City _ LQ �' - State ',ZIP
Phone # (� cl 61&Mail
Authorized Agent
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ZIP
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Agent or Applicant Printed Name
Signature `-*"Please read compliance statement on back of permits*y�}
Application Fee(s) Check#
Permit Officer's Printed Name
Signaturg
�--//�
Issuing Date Ex 1ratign Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have. authorized
g (S-°tv&?_tt -)od
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
in ��k er& County.
\ v,4 (4A-
1 furthermore. certify that./ 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:
Signature F
o L± i��
Print or ._ Name
Title
! 0
Date
This certification is valid through
RECEIVED
MAY 2 8 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
'I hereby certify that I own property adjacent to e V "-er— (—�(UW ( 's
(Name of Proper wt
property located at 5 vd (.��cf r 1A �s I lu >/�r(
� �C �� (Address, Lot, Block, d Rga
on ", etc.)
In 1� i�e c- t L 6 C N.C.
(Waterbody) (City/Town and/or County)
The ap licant has described to me, as shown below, the development proposed at the above
I n
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)
zzo do'o3��
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a mimum distance of 15' from my area of riparian access unless waived by m elf you
w' t aive the setback, you must initial the appropriate blank below.) �i�MVED
` I do wish to waive the 15' setback requirement. MAY 2 8 2019
1 do not wish to waive the 15' setback requirement.
(Property OwnAr Information)
Print or Type Name
10 `t (/Uo, -c L —4
DCM-MHD CITY
(Revised 611812012)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Own
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name#: nicG,
Mailing Address:
2(ol �
�1) We
f6ecr4
Pm
Agent's phone f �f
tAoce V-C/d
C.1
ty(_
2 ASS%
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 drawingtha development
they are proposing. �s�fiohardnavi��nieiots sl?io t�edtleYf.
4WI'have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, you mustnotifythe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response Is considered the same as no objectionlf you have been notified by Certified Mail.
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�WFD
wish to waive the setback, you must Initial the appropriate blank below.)
r•�r` I do wish to waive the 15' setback requirement. _ MAY 2 8 2019
I do not wish to waive the 15' setback requirement. DCM-MHD CITY
(Property Owner information)
Si nature
Print or Type Name
7 s5 fNoore 1-4,e
Mailing Address
,ems -II 6f54 NC 2-OS 3
City/state/Zip
_ 911 10 6 - `'I -)Oo
Telephone Number
FATE:
C
VA
M fling Addr ss
41) 8d�cy
City/state/Zip
,o 3-a �,?:::Z�
Telephone Number
a/9
Date "
Revised 611812012

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: % abp N�nvjL-k
Mailing Address:
M01 C
kz✓��✓�1,��lIL NL 7214L)
Phone Number: `-1-1
Email Address: y {�a]�o . Rio
I certify that I have. authorized f✓C� �4.n�i
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:r(
at my property located at -LZO A
in _ �c�� County.
1 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:
Signature
Print or Type Name
Title
Date
This certification is valid through
RECEIVED
APR 15 2019
DCM.MHD CITY

ADJACENT RIPARIAN PROPERTY ON/NER STATEMENT
I hereby certify that I own property adjacent to 's
property located at (Hama of Property. Qwner) .
(Address, Lot. Block, Road, exc4
on _ �i0r4C �tiy�i m la. ,G Vie, N.C.
(Waterbody) . (City/Town and/or Cou. nty)
The applicant has descnbetl to me, -as below,`the.developMont proposed at the above.
to
I have no objection to this proposal.
I have objeotions to this proposal..:
YICIY 1
h a site drawing)
doc(C ��p C
WAIVER SEQTION.:
understand that: a pier, dock, mooring pilings, breakwater, boathouse, tift, or groin must be set
back a minimum distance ofi Y5' from riiy area of :nparlah access unless waived b.y �m g. `f{ v�
wish to waive the setback, .you must initial thb.appro Hate blank below.). R96AV "
I do Nnsh to waive.the 16 setback requirement.
APR 1
I do not Wish to waive the 15' setback requirement, pCM.M
(Property Owfi& Iriformatlon) (Adjacent Property Owner Informatit
re ziriature
N kk c�y s vh
Print or Ty�Je Name Print or Tvpe Name
Cify/StateZZp
Telephone Number
Date
(Revised 611812012) i { .

l ADJACENT RIPARIAN RROPERTY OWNERSTATEMENT
I hereby certify that I own. property adjacent to�Cr
1`ZO (Name of Property. Owner)
property located at ✓ 5 1�� vc(7.
(Address iQt, �lock oed 'etc)
on �D✓cC�� h
-- in r'}icrh P ' SPaa . N.C.
(Waterbddy) . (Oity/Town andibi:Countq)
The applicant has described. It ine,. as shown below, thedeVelogment proposed of th8 above.
location: 1Y .
� ' i have no objection to this proposal:
have. objections to this proposal..,
(rnmvraue( proposing developmenf B ust f1/hn description below or aftach a site drawing)
WAIVERS QTION
I understand that. a pier dock, mooring pilmjls,breakwa(er, boathouse, lift, or groin must be set
backa minimum distance of`f5' f[om my area of.ri.p n h access unless waived by me. �f�ou .
wis°hh too waive the setback, you must lntttal the. appropridte blank below.),- �ECEwG . .
106 vnsh to waive.the 15' setback requirement. Zptg
RPR 15.
I do not wish to waive the 16' setback requirement. CITY
rrrtM MHD
(Property owner. ltifortnatlon)
Print or Type Name
_kY-22QVn ;lit I�1C
City/State/Z,elp ,
3x
Telephone Number
ti11L)h-e�
Date
(Adjacent Property Owner Informati<
Signature
Print: Type Narne
j1 oz: urns# � d
Mailing Address
2 v4-k 'VC, 1g5a)
CrfyfSt61012lp
6/7- 2fl
7�elepfiane Number
(Revised 611812012)