Lord Carteret Condo Assoc. Jim Cash

ICAMA / ❑DREDGE &FILL NO. 75901
L�JGA 8C ;D
ENERAL PERMIT Previous permit#
MlNew ❑Modification ❑Complete Reissue 7Partiaeissue Date previous permit issued
As autho ized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an re�pf envirOnm 'ntal concern ursuant to SA NCAC %1 '
/�1`,� � Rules attached.
Applicant N�mef l)(/ ! % %�( i)( // 1� L� / I f ro� t Location: County
Address %}� . ! ! / 1 ' 7 � Street Address/ State Road/ Lot #(s) _
State ;t' ..ZIP
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Subdivision
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Affected
AEC(s): ElOFA ❑HHF ❑IH ❑UBA, ❑N/A
Adj. Wtr. Body _
KVo-` I
Closest Maj. Wtr. Body
ORW: yes / PNA yes /;'no
Type of Project/ Activity
Pier (
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Floati
Finge
Groin
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A building permit may be required by:�
( Note Local Planning Jurisdiction)
Notes/ Special Conditions i
Agent or Applicant Printed Name i
Signature- **FI 'ea compliance statement on back ofF
1 t
- ❑ See note on back regarding River Basin rules.
�Z
Permit Officers Printed Name
r
ermit**' Signature
Check# Issuing Date -�i Expir!ation Date `,

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Perri: Co's �^
Mailing Address: L U r s Co,f (y--j.e .f-- Cum a rCrSC1 G+��i lcln
q�zo (1,.48v ccedc Cam\ R4I���l�
z-7�f3
Phone Number: q 19-- Y 77 — V7 9
Email Address: V-j FCC -rV-d1e'r6U*—bL) I dufS CCI. ✓�
I certify that I have authorized EZ, 70C-Y-, J7aVO NnJ (7C
to act on my behalf, for the purpose of applying for and obtaining fall CAMA permits
necessary for the following proposed development: �;L4L � o-
at my property located at 10 L 2. FPo ►JT
in e* County.
1 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:
ignature
Print or Type Name
- Lo i
Title
$ ZZ 1
Date
This certification is valid through

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: {))il L { I 11JDF PSI L(�21i1.K� TFL�T (b�� ;R``uc
Address of Property: IUI I iyw yt ")I, ?)U-\i 3F ck-( oWn E 1 GU
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
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.
F PO 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://www.nccoastalmanaltement.neMveb/cm/staff-listinn or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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.)
E Pb I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Pr nt or Type Name
Mailing Address
City/State/Zip
N i�i��F�i - (.-0( LD
IephoneNumber/ Email Ae'dress 171�{c{uta,
Date N.
(R��ii+pparia pr,(,VL n Property Owner Information)
Cam,-Q,t,& 11,1 Cl V P-n
Sign ure
F-t--12prib ;Tt-A-
Print or Type Name
sots FAUT sTREEr
Mailing Address
6EAorw-,N1, C. ,�,85/a
City/StatelZip
7 k- G
Telephone Number/Email Address
QCIC)bFR
Daze
(Revised Aug. 2014)
i

■ Complete Rams 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mallpiece,
or on the front If soars nn.mke
Ck215Lyt4K, CCC
PO Box -7-7-7(o
Cifleens boro, NC 2-7411
IIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIililll
9590 9402 4999 9063 5210 34
If YES, ent 8eiy1&ildress below: ❑ No
dult Sip ,yyp
7 Adults�a'R
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7 Adutt Signs dW oelive
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�Regis[erid Maii*e
13DJisr Mail Restricted
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7 Collect on Delivery IY@¢'
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<O Return for
7018 1830 0001 7702 1684 Delivery Res rioted Delivery 0 Signeturree Coonmatioon
I Restricted Delivery Restricted Delivery
Warm) PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt