Davis, Robert

^ El CAMA / ❑ DREDGE & FILL NO. 75902 A B C D
GENERAL PERMIT Previous permit#
C]New ❑Modification ❑Complete Reissue ❑ Partial , eissue 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 15A NCAC
i L_1 Rules attached
Applicant Name A ' Project Location: County t �_
JL Street Address/ State Road/ Lot # s
Address 1 I j _� \/ ( )
City_ 1 ( State li ZIP
Phone # ( )" `" E-Mail
lI Subdivision
g 1 /. �`(( i G `,
,J {
Authorizedent -
1ty f.. 1 \. _- ZIP
❑CW \ W PTA �]ES ❑PTS Phone # ( ) River Basin `
Affected g
AEC(s): OEA ❑ HHE ❑ IH ElUBA ❑ N/A Adj. Wtr. Body(nat /man—/unkn)
❑ PWS:
ORW: ryes / no PNA yes /./no Closest Maj. Wtr. Body '--- — � - -- -
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) .._.. _.
Floating Platform(s)
Finger pier(s) "-"""��.�•••---
Groin length
number _
avg aismnce t
max distance
Basin, channel
cubic
Boat ramp -
Boathouse/
Beach
Other
Shoreline Length
SAV: not sure yes o�.
Moratorium: n/a yes V 9
Photos: yes
Waiver Attached: (yes.. no
A building permit may be required by:,
( Note Local Planning jurisdiction)' i
Notes/ Special Conditions �(— jam/
`YI t-I-t-'lIf t ? , rI ,. 4,,k(;1 I
Agent or Applicant Printed Name
Signature Please read compliance statement on backof permit"
Application Fee(s) Check#
El
(Scale: j .i )
note on back regarding River Basin rules.
r
Permit Officer's Printed Name
Signatur
Issui� ng�ate Expira ion Datd

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Vobeiq-
Mailing Address: o ' ao u 670A
C�Fk,aae , Inc,
Phone Number: _
Email Address:
certify that I have authorized L:+G (bo6tG (����f��
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
rnC, 0
at my property located at \3 5unn� TCS� r�
in CCA-( {e r ems( County.
i 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:
—V 14d r�
Signature
P,,DhefA _X)aps_
Print or Type Name
Title
VD, 15 l R
Date
This certification is valid through
RECEIVED
OCT 16 ?19
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to PA1,bC,(+ D(3 VIS 's
(Name of Property Owner)
property located at k &-) flh Ll p0\ r-,A- ✓_,C Yf
on
ss, Lot, Block, Rc d, etc.)
In ,�CB�rf �f , N.C.
(City/Town and/or County)'
The applicant has described to me, as shown below, the development proposed at the above
IocaU'op.
✓ 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)
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 riparlan access unless waived by
me.. (If you wish to waive the setback, you must Initial the appropriate blank below.)
m ✓ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Informati n) (Adjacent Property Owner Information)
-�✓ <>
hire* C
i
Print or Tvpe Name
Talephonp Number/email address
VK)I
610(mkz k.
cc>n)
'`Valid for one calendar year after signature" (Revlsed Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Mhza , ,l_.l li i -:� 's
(Name of Property Owner)
property located at � �l9nb t}Irk
_ ` (Ass, Lot, Block, Road, etc.)
on dS Xat P ��y jc(-atr.(�., in I`IF}Q.�s 1 L �C Li ri P.�>�h' C , N.C.
- U (W erbody) '(City/town andlor 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
I have objections tothis proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, Ilft, 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.)
is ✓ I do wish to waive the 15' setback requirement. .
I do not wish to waive the 15' setback requirement.
Telephone Number/email address
Date
(Adjacent Property Owner Information).
Signs rwt l YY r
Print or Type Name
Date*
RQ
iL• CD m
(Revised Aug. 2014)
*Valid for one calendar year after signature"

ADJACENT RIPARIAN PROPnE�RTTY�OWNER STATEMENT
hereby certify that I own property adjacent to R&e -(- ,)a V t 'S 's
II yy (Name of Property Owner)
property located at V on 9�� I LO ty-�
_ (A dress, Lot, Block, Road, etc.)
on ? Cf-�OU CjiF:-~' k-., in KP l(L- �� Li ri � i � �J , , N.C.
(W� erbody) (City own 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
RECEIVED
OCT 16 2019
DCM-MHD CITY
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 requirement.
ation)
(Property Owner InfeZIA
(Adjacent Property Owner Information)
V, -�
Sigpture
Signature*
{1 6C(-+��V IS
Y
P ht or Type Name
P0.©, MI,',,
Print or Type Name
Sun(- � >
Mailing Address
CQ-S-tK !�e IBC a
Mailing Address
� IBC a l4
City/Sfate/Zip
Clty/State7zo
rlad�QhszWe n(Z,,�
Telephone Number/email address
Telephone Number/email address
tie(
I.oIQ1,g
Date
Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to tv),be,(+ c!WA5 's
- I (Name of Property Owner)
property located at
Nlil
In
and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
locall.
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)
gVCENED
0c, 1 g ?0
®CM_MHp CITY
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 requirement.
(Property Owner Inf�orm/ ati n)
Telephon Number/email address
Date
(Adjacent Property Owner Information)
C�
;ure*
f C i
Print or Type Name
S�L(n CGt f, fir,
Mailin Addr¢ss
C�c'ty/Biala ,
Telephone Number/emlifaddress J cnM
�Ot(s-fi«
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*