Laser, Kenneth

CAMA /,0 DREDGE & FILL No. 73969
GENERAL PERMIT Previous permit#
lNew ❑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
[`311ules attached.
Applicant Name kl t i iI i h �,> > 'r' Project Location: County t C r )
Address ) " X �� ~/ Street Address/ State Road/ Lot #(s)
City�State ZItP
Phone # ( ✓-) r /// -E-Mail Subdivision
Authorized Agent Cityi f ' ZIP
0CW
[IEW PTA ; EtJES ;; 9
Phone # ( ) River Basin
Affected
AEC(s):
❑OEA
❑HHF ❑IH ❑UBA ❑N/A
Adj. Wtr. Body' i �"±. i I -� e-� (hab'� /man /unkn)
❑ PWS:
,i
Closest Maj. Wtr. Body
ORW:
yes /i no
PNA (yes /no
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Agent or App(cant P rimed Name
Signature "Please read compliance statement on back of permit
_ 1�yG
Application Feels) Check #
PermitOfcer's Printed Name .l
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit k IM e �
Mailing address: 7, ID , Bo x q ,4 `]
_OV=i 97r-�7WL ` t,i C.— 2-8571
Telephone Number: 257-- 2-4.9 —O+2"Z
I certify that I have authorized Clon �C 'trug m� ! h ,(agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of. h'. SO LC'
+6 l o`V4 ' '
at my property located at
This certification is valid through 1 a 7 -19 (date).
(Property Owner Information)
Sign Lure
Print or Type Name
(3w,\P-
Title, co. owner or trustee for property
O Ay
Date
LS2 ^29,T-c?,�2z
Telephone Number
keN If- k-� Lr?sS 4�M
Email Address

U.S.
Postal
Service"'
CERTIFIED
MAIL°
RECEIPT
Domestic
Mail
Only
For
delivery information.
visit
our websile
at www.usps.com',
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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: K2 yt L o SPAY -
Address of Property:
N, qq
AN
(Lot or Street #, Street or Road, City & County)
fir, 66 Ls- o G.,
Agent's Name #: C.Ov\S'Cnnc ; m �� c . Mailing Address: 6 00 3
Agent's phone #: 01- I La 1 -1 Cr «yak sSL r5Y')c Aj G a $S a g
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.
l' I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you mustnoW the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at lsf o:!/v✓y, v ncco_a rQlm9na rent,n&L1v b/cm/staff-lis7iogg orbycatlinp t-888 4RCOAST.
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 o waive the setback, you must initial the appropriate blank below.)
I do wish to %4ve the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pj` rJ ope� Owner Information)
lore /3o t,G C`� c C shsfrket �� -
ignature
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Mailing Address
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City/State/Zip
oqsa -Fyn _ oya,a
Telephone Number/Email Address
Date
Information)
I. (" Jel- I
Print or Type Name
Mailing Address
f Il
City/St te pp
i
Telephone Number/Email Address
Date
(Revised Aug. 2014)

KEN LASER
97 SERENITY CIRCLE
ORIENTAL, NC
DESCRIPTION
We propose to install approximately 50 linear feet x 3' high Class B riprap and
filter cloth along the shoreline at the area where the pier connects to land.

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