Fulcher, Dale

,W CAMA / J DREDGE & FILL No. 75745
A 8 C D
GENERAL PERMIT Previous permit#
CPNew ❑Modification []Complete Reissue ❑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 15A NCAC
Rules attached.
Applicant Name .� ; ! ! r 1._ l Project Location: County
I f.
Address:." 4 Street Address/ State Road/ Lot #(s) !
City L State^ -I ( ZIP_ —
Phone #
Authorized Agent
Affected eW
AEC(s): OEA
❑ PW:
ORW: yes / no
/ E-Mail
.NEW ]PTA _©ES ❑PTS
❑HHF ❑IH ❑UBA ❑N/A
PNA yes / no
Subdivision
ZIP
Phone # O River Basin
Adj. Wtr. Body(nat /man /unkn)
Closest Maj. Wtr. Body #
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avg distance offshore
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max distance offshore-_
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Agent or Applicant Printed Name
Signature `- Please read compliance statement on back of Permit"
Application Fee(s) Check #
Permit Officer's Printed Name :'1
Slgnatur /
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Dal? Fl lrh er
Mailing Address: a 0( Swan B© I t e d-
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits p necessary for the following proposed development: af,f 2C'( (ES � C< QCL
at my property located at �c
in V rS . w County.
I 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
ovine/
n Title
Date
This certification is valid through / /

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: Da w
51 C.
Agent's Name #: ` K,)&g hoc ber Mailing Address: VI m I O I n1 Ly)
Agent's phone #: SR-)-135('9 08� 60
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 drawing the development
they are roposing. A description or drawing, with dimensions, must be provided with this letter.
9 1 have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at httn://www.nccoastalmanagement.nettweb/cm/staff-listinu orby calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a riimum distance of 15' from my area of riparian access unless waived by me. (If
you wishto give the setback, you must initial the appropriate blank below.)
lie I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Ow er Information) (Riparian Property Owner Information)
Signature Signature
rL r`)1 K 4Dehrck Lewis
Print or Type Name Print or Type Name
�}Mailing Address / l Mailing Addjress�p /1/1 / �2I, /�
City/St�e2 p�l �I � v C Sid t c 11 1 i A 1�I C, d' qW
Telephone Number/Email Address Telephone Number/Email Address
Date Date
(Revised Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: I ,1�3 Pac C S -ee ¢- St NC
(Lot or Stfeet #, Street or Road, City & County)
Agent's Name #: �O`) n `) P 1, CMailing Address: 1l jolo n
Agent's phone #: �(�li �Jl ��'�lc�Gj �r I L kds T-f' nu d ( ' `i Ip o
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 drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http-(lWww.nccoastalmanagementnetlweb/cm/staff-listing orby calling 1-888.4RCOAST.
is considered the same as no of
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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) (Riparian Property Owner I formation)
Signal t Signature c,
Do L ` -u I Ch r-i� i I I �lnrv� � (arb�ara Cwrc�r n
Print or ype Name Print or Type Name
�U� S'\,�jC(Q 2oI n �r CiV\ iztIFl C',
Mailing Address Mailing Address
.S► i cad s 1-m:wNC aPH U C (YIYI�CIY
City/State/Zipty/StatelZip
Telephone Number/Email Address Telephone Number/ Email Address
Date Date
(Revised Aug. 2014)

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