Gurley, Judy

^ J�CAMA / 0 DREDGE & FILL No. 75283 A B 'C D
GENERAL PERMIT Previous permit#
,Mew ❑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 I SA NCAC
E Rules attached.
Applicant Name ` ! I "I Project Location: County
Address (' I ` Street Address/ State Road/ Lot #(s) (i / i
1 State 1 / ( ZIP
Phone # O / 11 E-Mail
Authorized Agent
if ,
Subdivision
9w
Affected ❑ CW ,DEW ❑ PTA LIES ❑ PTS Phone # O River Basin l l'' ,.
AEC(s): ❑OEA DHHF CIH ❑UBA ❑N/A Adj. Wtr. Bod/(nat /rrian /unkn)
❑ PWS:
ORW: yes / no PNA yes / no
Closest Mal. Wtc Body V C_ �
Agent or Applicant Printed Name/ /;
l i �,/
Sign ire '**PIQas ea comJance staenn ton back of permit *'ty
Application Fee(s) Check #
Permit Officers Printe Na a YA
ray
i ct.ti.i
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
NAME OF PROPERTY OWNER APPLYING FOR PERMIT Judy Gurley
MAILING ADDRESS
TELEPHONE NUMBER
6011 Brig Ct
New Bern, NC 28560
252-633-5432
I certify that I have authorized Dan Foley (agent/contractor) ,
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of Bulkhead
at my property located at Same
This certification is valid through (1) Year (date).
(Property, Qwner Information)
1 Sig"ture�
Print or Type Name
Title, co. owner or trustee for property
Date
Telephone Number
Email Address

Adjacent Riparian Property Owner's Statement
Adjacent Riparian Property Owner:
Section Number:�_
Name: _ m �iit-
Address: 9 K (
Telephone Number:
E-mail Address:
Lot Number: ITS
I hereby certify that I own the property adjacent to:
Section Number: -� 5 / Lot Number: f l
Owners Name: \ /(.) AI A
Address:
Telephone Number: -- L'-S Z
E-mail Address: t�t-P` ?tl (� U
A
The individual applying for this permit has described to me the scope of work as shown on the attached copy of the
"Description and Drawing of Proposed Work" form and have no objections to the proposed work. I understand that
docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet (15'-011) from my
riparian line unless waived by me.
I do not wish to waive the setback requirement.
_1/I do wish to waive the setback requirement.
Adjacent Riparian Property Ow er: ;
Signature
Print Name
Date 61 oZ 1 �) Cj
1 j�tl Ole,
CoIIII{,�

Adjacent Riparian Property Owner's Statement
Adjacent Riparian Property Owner:
Section Number. �0 Lot Number:
Name:
Address: I omc1 ' ��t� \ou 3Svor\ WC.2 -
�
Telephone Number: UU.'�)'(CJ 1-1 "
E-mail Address:
1 hereby certify that I own thepropertyadjacent to:
Section Number: J Lot Number: C�
Owners Name:
Address: JiUJJ ln<\ -J 1
Telephone Number:
E-mail Address: QCa-(YQ x `e ( (:A )w' cb- -"
The individual applying for this permit has described to me the scope of work as shown on the attached copy of the
"Description and Drawing of Proposed Work" form and have no objections to the proposed work. I understand that
docks, pilings, tie poles or any other marine structure must be set back a minimum of fifteen feet (15'-0") from my
riparian line unless waived by tie.
I do not wish to waive the setback requirement.
I do wish to waive the setback requirement.
Adjacent Riparian P operty O er:
Signature
Print Namve ro
Date -; ,' —, �