Butler, James

BAN A / ❑ DREDGE & FILL No. 73987 A B OC D
GEP' ERAL PERMIT Previous permit#
"4gew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authcized,by the State of North Carolina, Department of Environmental Quality L/ "7 C/!,�
and the C:osstal Resources Commission in an area of en onmentaI concern pursuant to 15A NCAC / p� V
❑ Rules attached.
Applicant Name � G / 1'P% f J '✓ � l Project Location: County Y
Address
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Agen[ or Applicant Panted Name
Signature "Please read compliance statement on back of permit
t
Application Fee(s) Check #
Permit0�f .f s Panted Name � - _
Signature
Ld
Issuing Da a xpiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 3afy 's -P,
Mailing Address: I0Z hG8en5 Cr)O(- ETC151`
Phone Number: —2506-`)08 a
Email Address: ('ac► dD mG nC.. uS
I certify that I have authorized 1- i a l-eaoci/ NC C005io k Federafl06 ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: QusterSKI--Il haq
IY)CLCSk s+ It AICLA-5A -Fek- f7- uet"n(-
at my property located at ID8 E IY) :t-.. Ct'd/ f �I of N.C, u5sq
in CGf-k'-Ce.% County.
l furthermore certify 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:
Signature
Print or Type Name
Title
Date
This certification is valid through

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Jary)e '�- f %tf i s
property located at lug _-e CYIQ qen&Ci• (Name of Property Owner)
on _ PoG fx vcpU11 (A dress, Lot, Block, Road, etc.)
in reclCir (�Ot F ,N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location,
_V"_ I have no objection to this proposal.
I have objections to this proposal.
AND/OR
WAIVER SECTION
DEVELOPMENT
I understand that a pier, dock; mooring pilings, boat ramp, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Lv Information)
Sin e
James R Butler
Print or Type Name
!08 mageascova caS-<-
Mailing Add ss
C1--CIaP Po-,n >`1C �sS84
Citylstatelzip
a5z,%t)K =�DBZ /rnda7rnarlc vSS
Telephone Numberl small address
ss T
4/4/19
Date
(Adjacent Property Owner Information)
732-259-9101
Telephone Numberl small address
4/4/19
Date'
"Valid for one calendar year after signature" (Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ Jan-zs 2.), -�tJ to tr" 's
(Name of Property Owner)
property located at 1 b� E MQg �� Cf
on l)�� sour-',d (Address, Lot, Block,
Wa'''r\ etc.) , N.C.
(Waterbody) (City/Town and/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.
AND/OR
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
✓ I do wish to waive the 15' setback requirement.
i do not wish to waive the 15' setback
(Property Own r I formation)
? ./.. -
Signature
ames R Butler
Print or Type Name
Melling Add ss
Cedar ttt C QT584
citylstatelzo
olh2-SOS- ]t�2i rod d)M)C, u5
Telephone Numbe /email address
04/04/2019
Date
Owner Information)
5igna "
r�rn M , I
Print or TV6 Name
110 Magens Ct E
Cedar Point NC 28584
..nyiomiaiup 91-0-358-0070
[e-mail]
Telephone Number/email address
04/04/2019
Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature"

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: JaY-P5
Mailing Address: ha
genS Count- EFa5i"
CedCxC i701r4, gc, a.$S94
Phone Number: a5- —18(g~^)09 a
Email Address: rod cry mqnc.. US
I certify that I have authorized L�Xi o, tic om/ NC Cb0S-VC lk
Agent 1 Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
n ecessary for the following proposed development: pttSter' S{�I1 hcrG
f`1CL(sh s; U-IfnCucsk -fo-. muerm�hF-
at my property located at VS E MQ9(-n5 Q+t) Cj-,dnf
In E£C P 1' County.
I furthermore certffy that I am authorized to grant, and do is 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
Signature
James R Butler
Print or Type Name
Owner
Title .
4 4 1 2019
Date
This certification is valid through