Henry, Jon & Lorah

❑OCAMA / ❑ DREDGE & FILL NO. 74927
GENERAL PERMIT `P Previous permit# A B %c D
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued l
❑/
As authdrized 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
. Ru
les attached.;
Applicant Named i '4 L f I" (' i i( ' �.. -.�- . Project Location: County_ (� '
Address
Street Address/ State Road/ Lot #(s)
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Affected
AEC(s): ❑OEA
❑HHF 'El IH ❑UBA ❑N/A
Adj. Wtr. Body _ -
- (nat--man_/unkn)
❑ PWS:
ORW: yes 110
PNA yes / no
Closest Maj. Wtr. Body_
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Agent or Applicant Printed Name
Signature '* Please read compliance statement on back of permit
PermitOtfcer's Printgdfame
Signature
Application Fee(s) Check# Issuing Date Expiration Date

J O•�r
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ZA, Log'I /f IkA/rzl
Mailing Address: go,-, P UAi ;p D iZ.
Phone Number: 2 S 2 -7 z S ' 5-7 1-
Email Address: i A� ¢ 1 A! - F f 6v✓�'7
I certify that I have authorized Agent / contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
development: LIS: V fu--
necessary for the following proposed
Z'ls 1 L
at my property located at
in —CA ' '" County.
horzed to grant ' do
in fact grant
l furthermore certify that lam a staffr the Local PermitOfficer and heir agents for enton er
Division of Coastal Management
on the aforementioned lands in connection with evaluating information related to his
permit application.
Property owner Information:
Signature
2
Print or Type ame
Title
l -`-
Date
This certification is valid through RECE'vED
t�1AY 3 0 2t)19
_. DCM"nfiFtD CITE

512912019
IMG_2198JPG
IfN
t
RECEIVED
MAY 3 0 2019
DCM-MHD CITY
https:llmail.google.corn/maillu/0/6seamh/jhenry%40bahoft.com?projector—I I/1

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONfWAIVER FORM
Name of Properly Owner. 'Z ✓ S G o/Z6i ll k6w '. �z
Address of Property: 109 %'��./D Di2 Fi'TLRA/T-TL a:Ae/t� i✓L
(Lot or Street #, Street or Road, city & County)
Agents Name#: .NiI)iZx/,#alling Address:
Agent'sphonelk 25Z 72.i.3%tZ3
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 descriotion or drawinu with dimensions, must be ItrOvid0d with this letter. —110M,
I have no objections to this proposal. Ut1" I have objWions to this proposal.
ffyou have objections to whatis being proposed, youmusrnotilythe Division ofCoastat Management
(DCMj in writing wuhin le days of receipt of this notice. Contact Information for DCM oKres is -,- Me'�dA lw/'
available athtrn7Avww necoash, nagementneftehicmrstaN-listing orbycallingi-888-4RCOAST..
No ma .n is considered the same as no oblectiun It you have been nowled by Certgled Mail.
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 initlal the appropriate blank below.) RECEIVED
I do wish to waive the 1 V setback requirement.
k I do not wish to waive the 15'setback requirement.
(PropArrty Owner jpfornaUon)
llure J
Print or Type Name
35-2 q Rock CgFP �iZ.
MallingAddiess
%L& LGr},WC: 2.7Ga�
Cify0aleMp
MAY 3 0 2019
f30A4'MHD CITY
Ri art n Pro a O er Information)
Mignolure �1 /1 /
Ko 6 e yt,
Print or irype Name
192 /,�1eeckeli,'
Melling Address
/Vec 1 _W /0012-
Citylstate2ip
252.7Z. 26-7 j J�trat� @6c+tivfr (0`ll0 9�7-(a/3Z V�eacoe%��rnb/2iv+
Telephone Number/EmaflAdd�•Coi%TelaphoneNumberIEMOI(Arldress
'-lZZ -'�- // 9 " "-d—; DDI I
Date Date
(Revised Aug. 2014)
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RECEIVED
MAY 3 0 2019
DCM-MHD CITY

tit,
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
t..
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. .Io.J f L oizel /f NeszzZy
i
AddrossofProperty: 209 Pc1.ID D/Z Ar✓ Ljq,rie zdi&.W6
n (Lot or Street 0, Street or Road, City&Court')
AgenCsName#:[zL,.U,6 G/arie,Z P9Wx4pailingAddress.
Agent's phone 2-,T'Z. 72^3-3 5-Z3
I hereby certify that 1 own property adjacent to the above referenced property. The Individual
applying for this pemdt has described to me as shown on the attached drawing the development
dtey proposing. A descriptlod or drawing with dimensions must be provided with this letter.
I have no objections to this proposal I have objections to this proposal,
aveobjecdons to wbatfsbefng proposed youmost noWyihe Dfvlslon of CoosWManagement
In wridng wfNdn 10 days of receipt of Mfg nodes. Contact Informadon for DCM offices is
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 Iva the setback, you must initial the apprdpriate blank below.) (p� f
I do wish to waive the 16 setback requirement. 1 - re-0 `.>eCX/��`,-
1 do not wish to waive the i V setback requirement. t �C a�Wt9 7- 19
(Prop Ay Owner oration)
(Riparian Property Owner Information)
/e�`-l-/-[ &- tGOCI{
i lure
B,✓ �,r;,i/i2 ✓
Signature -L J Gam" J /
k(C 6 2 r f pe n'C O c�L
Print or Type Name
35-2y Rock G/Ir
Print or Type Naas
/PGc/ar 7
Mating address
&/'J�«a we- 2-7Gaq
McHing Address
New �� C ivy I0012-
Ctly0afefLlp CifylBfetaop
26-27Z5-.2S"'1I �Jlu,r���a�u�^t (bf&-''(`f7-6132 rPeuCoc/c�
Telephone Number EmsflAddross T
41 /z s // 9
•CunTe1ephom1Vumber1EmsCAddiess
7- 9- )-oi?
Dare
Data
(Revised Aug. 2014)

DATE:
JOB:
MANUFACTURERS REPRESENTATIVES SINCE 1949
DIVISION S AND DIVISION 10 SPECIALISTS
W W W. S BSASSOC.CO M
1530 HILLCREST ROAD
NORCROSS, GA 30093
[phone]
FAX [phone]
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