Benson, Tom

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NCAMA / ❑ DREDGE & FILL No. 75024
A B C D
GENERAL PERMIT Previous permit#
,NNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ;
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ _ Rules atta hed.
Applicant Name i) Y:'f' r :' ( Project Location: Countyr 1 G
Address X / /f Street Address/ State Road/ Lot #(s)
City State ('( ZIP
Phone # ( ) / - � / E-Mail
Authorized Agent
Affected 0CW bEW Jn PTA DES ❑PTS
AEC(s): ❑OEA ❑HHF ❑IH El USA ❑N/A
❑ PWS:
ORW: yes / no PNA yes /ono)
Type of Project/ Activity a— I • r J )
Pier
Fixe
Floab
Fing
Gros
Bulk
Basil
Boat
Boat
Beac
Oth
Sher
SAV:
Mo
Phot
Waiv,
Subdivision
City j d hi in I� ''�f� lE' ZIP,
Phone # ( ) River Basin il
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( Note Local Planning jurisdiction)
Notes/ Special Conditions
(Yw t1 (r ` I
Agent or Applican�inted Name `�
Sig�`*I�Te read compliance statement on back of permit**
r
T111
Application Fee(s) Check #
PermitOfNcer s Printed Name
i
SignatSignat re 'I
(�p/�
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Q� r�� t.1 -;" lJ,j
7 �
Mailing Address; 1 12S 0'-� ) L,
Phone Number: 2 2 2 3 q I l
Email Address:
certify that I have, authorized m V f1 c - I�
Agent /
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: I I ilJ---, � r3 1 � I � :j *�'� I I -F t-
at my property located at ,Z 14 12
in 4 /4 n -T t-' G' County.
I furthermorecertify that l 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:
O M hr< IUS<. w
Signature
Print or Type Name
Title
5 / Z( t )f1
Date �—
This certification is valid through
RECEIVED
JUN 12 2019
DCM-MHD CITY

01/25/2008 04:53 19762275131 GERALD JANETSMITH PAGE 02/02
I hereby codify that I am property adjacent to r.7 -,� E r✓ 0 w 's'
PMPeltD' located at Z Z 0-�3 I t s..6 7 r i av • t=
}�> o S o . D aracu, rcoaxe,
an ccc f
in i tv te' .KC.
(' bodgj (Cityffawn arwor CO~
Ow
/6
°S S
FX
V
�1 SfC� L,rT7-
I WAMM SECngjq
I tardexsmrrd that a pier dock, rnoormg Pamw boat ramp, breakvna , boathouse, IA or groin
most be set back a mktbraan &gartce of 95' from my area OT riparian access untess Waivad by
one- (# you wEsh to Waive itm setback, You mlmt- itlifial the appropriate Mart k below.)
I do wish to waive the 15' setback mcmdrement
)/ 1 do that wish to waive the 15 setback requirement_
ILo
-2 S'2 z K 3 `h) } 0
T Nwnber/nmaaad*n
cam-/l
m .
'Varid for one calendar year aRersisrrrature'
(Arrpa.hent Prop P6ijDr►nahon)
JhdMA� " Ij V `
'99� 12" el
�n p C
TeJe(ilsa�o�Ncyarb�rl erne!! aCC,ews
RECEIVED
JUN 12 2019
DCM-MHD CITY

ANAMff- RiPA-MM PROP©tTy QmJER K&1[ IlEKr
t hereby Codify brat t own property adjacent to �T-o"-t j; j� "a w;
's
properly located at Z Z 6 O .8 X l rr 4- � i7t i vb � p�� rty Ownerj
on- 1� a 5 rrkaF S©r (d► + h3todt, Road. )
in r iv ke 1(-hrz t j > Lore 5 N.C.
t Y) (tWi'own and/or County)
The applicant has described to me, as shown below, the development proposed at the atxrve
location.
I have no objection to this proposal.
T3b�x
i�
r hb
< IL= _ —1 Sa} Slct� Li t
g
I understand ttrat a pier dock, ' twat ra$gran !
must rset bade a mpbreakwaterboatimul,
. , bit. or ... n
minirrgtm Cktance d' 1V iron my area of riparian access unless received by
me tit You wLsh to waive the setbacks. you niust initial the approp"ale trunk bebw.)
fX
h do wish to waive the 16 setback ►equiremenL
h do not wish to waive the 1-5 setback requirement
(PrOPorlY OM"
)(!AY � x 7F
t_rrtgau
�y3 �1to
rakabOne Nmr9wlemw7 address
lAV2
Wald � wra cater,der year atteragnature•
RS5)�
(Revised AM 14)
RECEIVED
JUN 12 Z019
nrM-MHD CITY