Fields, Jean

®DCAMA / LJ DREDGE & FILL No. 74494 JQA B C D
ENERAL PERMIT It 'Q Previous permit
{slew ❑Modification ❑Complete Reissue ❑Partial Reissue Date r vious permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an a ea of environmental concern pursuant to 15A NCAC 'V.
I - JL Rules attached.
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Agent or
Signature
Application Fee(s)
me PermitOfficer's Printed Name�-
i
amplian statement on back of perm tom*'* Signature
��Check Issuing Date f=xpiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Jfg� Aeud s ,dy DW4r,*e L Ge_-ks
Mailing Address:
Phone Number: 615- 174/6- 5e�11161
Email Address: Ol_lr",e1A -02 I5/4-A Go
I certify that I have authorized 7'o.„ r u_r.,y,,t
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: e 0rAl- St&rlay OP
ooC/L- 'f., i kL /GY FYon /{,,4t Ll GT'
at my property located at / 2 5 Gore />� GueS f /ho /2ea� G :<� AIL
in t County.
I furthermore certify that I 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:
jS zc&L /� �3,1k4:��
Signature
Print or Type Name
Title
3 / Z 1�
Date
This certification is valid through V /_//d RECEIVED
MAY 0 3 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
/d /J
I hereby certify that 1 own property adjacent to few- Jew;.,Jew;.,G. e s F X Pc: clw ^ s
(Name of Property Owner)
property located at /Z5 ee, f
/ (Address, Lot, Block, Road, etc.)
on %jyo;ve 5 2d in 1,10e,Ae�l G%i
(Waterbody) (City/Town an
County)
N.C.
Theant has described to me, as shown below, the development proposed at the above
local io
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 orattach 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 riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
i
/ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
S-riignatulre
/ /
Print or Type Name
Mailing Address
t4, e��wya�t T�' 37427
City/State/Zip
Telephone Number/email address
3 - / - zo/9
Date
(Adjacent Property Owner Information)
Signature
Q cY�yn�. L. //eGc15
Print or Type Name
/;z 7
Mailing Address
�t�'� /
City/State/Zip IV/4 e/s'o,-/v
Telephone Number/email address
3-/-zo/61�
Date*
RECEIVED
(Revised Aug. 2014)
*Valid for one calendar year after signature'
MAY U 3 Z019
DCM-MHD CITY

There is an existing dock of 316 Ft. The first 136 Ft. is four Ft. wide and there is a 6x10 deck on the right
side with steps down to the bottom. The second half of the dock is 186 Ft. and is four Ft. wide with a
6x16 ft. deck to the right. We want to widen the second section to six Ft. and increase the outer deck to
a 14x16 and install a boat lift on the right side.
Clto
u
D
a
RECEIVED
MAY 0 3 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
by 0wwYn�
I hereby certify that I own property adjacent to ✓e«n J e w:5 f �5 GXCc ViV1' 's
(Name of Property Owner)
property located at /� 5 Go•�� O� lives �
(Address, Lot, Block, Road etc.)
on C- in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
��& K 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 orattach a site drawing)
50- n77469 h���
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 Information) (Adjacegt Property Owner Information)
Signature
rem t /'-U.s fells 6y ��time fell
Print or Type Name /
Mailing Address
���2� �v 372%2
City/State2ip
Telephone Number/email address
3 -Z — 26;/
Date
*Valid for one calendar year after signature*
or
Mailing Address
✓I'jt-�Al) ctiQ -28'CZ5i
City/State/Zip
� 2-ddI-6q-) co
Telephon7�l
Nu ber/email address
3z �
Date* — I t-4ECEIVED
(Revise MAY d31 hig
IDCM-MHD CITY

There is an existing dock of 316 Ft. The first 136 Ft. is four Ft. wide and there is a 6x10 deck on the right
side with steps down to the bottom. The second half of the dopk is 186 Ft. and is four Ft. wide with a
6x16 ft. deck to the right. We want to widen the second section to six Ft. and increase the outer deck to
a 14x16 and install a boat lift on the right side.
r"Y�TA
1
Q
'z
RECEIVED
MAY U 3 2019
DCM-MHD CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
�5 15 `I55 - 5'd cl6l
I certify that I have authorized iomW r v4ZtAav-15 252 S�/H— ! $ L
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: j,,,nw,. 0 arxl�— 5e&?'ic+ OP
Do(ili -f, Ste- r-%z rYnn liana' "i-7'
at my property located at 4- Aef�f / l <^c / «� G �y zo'--
in /- County.
I 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:
FLU 4•i-J�CIe^2,. G._c=Y�'��- Al
Signature e
Signature
fz'ii✓L Geec<•s A/L /, /- /�/s
Print or Type Name
�kc'Gv%ty
Title
3 12 /
Date
RECEIVED
This certification is valid through `,7'
MAY U 3 Z019
DCM-MHD CITY

There is an existing dock of 316 Ft. The first 136 Ft. is four Ft. wide and there is a 6x10 deck on the right
side with steps down to the bottom. The second half of the doFk is 186 Ft. and is four Ft. wide with a
6x16 ft. deck to the right. We want to widen the second section to six Ft. and increase the outer deck to
a 14x16 and install a boat lift on the right side.
oAT Glt'r
7iTR�9 fineij- %3� T 1�
S
wi4;,v ifhi yA67'10U 0 P
10 J
j0i
RECEIVED
MAY 0 3 2019
DCM-MHD CITY

CERTIFICATION OF VITAL RECORD
STATE OF NORTH CAROLINA
CARTERET COUNTY
OFFICE OF REGISTER OF DEEDS
NORM CAN.U...PAHLf. ,TTAOEgjr&hE%aNO HUMAN BERVIGE9
pElppT� CERTIFICATE OF DEATH
pBTAICT NO. �/ LOCALN0. COVNTV OF OEAMC Tt t BTATEFRENO. 401
OECEOB.1. LEDAL NAME
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Volume_ 101 pge494
ce This is to rtify that this is a true and correct reproduction or abstract of the official record filed in this office.
Karen S. Hardesty
Register of Deeds
Carteret CounW
Witness my hand and official seal
this the 11 th day of July 20 18
DHHS 3914 (REVISED 5/09) NC VITAL RECORDS
RECEIVED
MAY U 3 2019
DCM-MHD CITY
Any alterations or erasure voids this certificate. Do no accept unless on security paper with Register

STATE OF NORTH CAROLINA File No. [l—
�l 18-E-
In The General Court Of Justice
Carteret Su Court erk ion
County Befor the Clior
IN THE MATTER OF THE ESTATE OF:
LETTERS
Name
Jean Lewis Fields
G.S. 28A-6-1; 28A-6-3; 28A-11-1; 36C-2-209
The Court in the exercise of its jurisdiction of the probate of wills and the administration of estates, and upon application of
the fiduciary, has adjudged legally sufficient the qualification of the fiduciary named below and orders that Letters be
issued in the above estate.
The fiduciary is fully authorized by the laws of North Carolina to receive and administer all of the assets belonging to the
estate, and these Letters are issued to attest to that authority and to certify that it is now in full force and effect.
Witness my hand and the Seal of the Superior Court.
Name And Address Of Fiduciary 1
Date Of Qualification
Curtis G. Fields Jr.
10080 Meadowknoll Drive
Loveland, OH 45140
Clerk Of Supe rt
4 �CSon
nC;
Title Of Fiduciary i
Co -Executor
EX OFFICIO JUDGE OF PROBATE
Name And Address Of Fiduciary 2
Date Of Issuance
Dwayne L. Fields
1252 Concord Hunt Drive
Signatu e
Brentwood, TN 37027
Title Of Fiduciary 2
Co -Executor
❑ Deputy CSC Assistant CSC ❑ Clerk Of Superior Court
SEAL
RECEIVED
NOTE: This letter is not valid without the official seal of the Clerk of Superior Court.
AOC-E-403, Rev. 7106 MAY U 3 2(11,9
© 2006 Administrative Office of the Courts
OCM-MHD CITY