Floyed, Alexander

®NCAMA / ❑ DREDGE & FILL No. 75909 A B C D
ENERAL PERMIT "+'Rreviouspermit#
``ew ❑Modification []Complete Reissue ❑Partial Reissue Date previous pgtmit issued
As au4rized by the State of North Carolina, Department of Environme tal Quality ! .
and the Coastal Re ;pure s Commission in an area of environmental cone rn pursuant to 15A NCAC ,
1 I iRules attached.
Applicant Name �5(I i �( 1 Project Location: County r a
Address 1 - Street Address/ State Road/ Lot #(s)
CityState Al. i ZIP % .1 A i l
Phone #
Authorized Agent / / J / / f--
Affected 0CW ❑EW [I PTA El ES ❑PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ IJBA ❑N/A
❑ PWS:
ORW: yes / no PNA yes /, no ,
Subdivision
City i I 1� -.l (/ 1 ZIP
I , /
Phone # O River Basin
Adj. Wtr. Body Jt) - I k (nat /man /unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature ra Please read compliance statement on backof permit"
Application Fee(s) Chec #
PermitOfficers Printed NaMe
Signat re
rrlrg
Issuing Date 'Expifation Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �/ tcI
L��, �D ,e!
pA J Mailing Address: a A.3 W m f 6, Uh �e��
� rt1E1
Phone Number: 9) c7 7 yD 2— 4 0 I
Email Address: �'i�{xo�lo� (V -r)ayr^a
061 C0Am, 0/ y
I certify that I have authorized H I' � 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: VI U LA\ r -�, �✓ r t e.
1 --t �1 UP 4 r rL O i -C/lCf 01
at my property located at
in
/ 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:
't/� �&&- —
S slur,/
tGSx ale" 'fir. RECEIVED
Print or T pe Name
Liuwe� OCT 24 2019
Title OCM'MHD CITY
Date
This certification is valid through 12- 1 3 1 1 11

'� f
i
re
� t i
J.
RECEIVED-
2019
DCM-MHD CITY
�• �, aDi9 v
w

ADA C T RIPARIAN PROPERTY OWNER cTOTEMENT
I hereby certify that I own property adjacent to �� Fx6j !I D
(Name of ProaedYOwned]
property located at t 7 .rFI - --
(Add reas, Lot, Blo k, Rpad etc.) �) N.C.
O
on .ydlE �aCPF4 in 11Jl0 �t f T
(Waterbo(City/Town and/or Couwry)
The applicant has described to me, as shown below, the development proposed at the above
location..
' I have no objection to this proposal.
1 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual propos/ng development must fill in description below or attach a site drawing)
/ RECEIVED
OCT 24 Z019
DCM-►4HO 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 riparianote accblaess
unlebelowss waived by
me. (if you wish to waive the setback. you must initial the appropriate
I do wish to waive the 15' setback requirement.
( I do not wish to waive the 15' setback requirement.
Ad scent Property Owner Information)
(Property Owner information) - (/./
G�
)er / email
'Valid for one calendar year after signature'
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
MI r 14 1ih=0 'a
I hereby certify that I own property adjacent to
property located at ° (Address, Lot, Block,Rpadd etc.)
a Ontt�r-� 9�eYf N.C.
on ���� �� in rs�, (Cityiiown and/orCou )
(Waterbody)
The applicant has described to me, as shown below, the development proposed at the above
locatio
6- 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing davelopwmOnt Must fill In d�$Cripflon below or each a SRO drawing)
RECEIVED
OCT 24 2UJ9
DCM-MHD CITY
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, groin
must be set back a minimum distance f 5' from
initial thea of riparian
appropriate blank elow.)s waived by
v
me. (If you wish to waive the setback, yo
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Vale
"Valid for one calendar year after signature'
(Adjacent Property Owner
Print or Type Name
Mailing Address
CityCity/Scat �pp, ��
2„fL
�Teleephho""neNumber/ em /address
Unre "'
(Revised Aug. 2014)