Mabe, Bill

'J CAMA / ❑ DREDGE & FILL No. 75290 A B r"C D
GENERAL PERMIT Previous permit#
JNew ❑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 15A NCAC
E9 Rules attached.
Applicant Name ( Project Location: County
Address �, 1 i !' K i i t . Street Address/ State Road/ Lot #(s) i
City State i l ZIP
Phone # ( ) ` "Z E-Mail Subdivision
Authorized Agent (' City ZIP
Affected ElCw bEW ❑PTA ❑ES ❑PTS Phone# ( ) River Basin
❑OEA ❑HHF FIIH ❑UBA ❑N/A
AEC(s): Adj. Wtr. Body + .� { ,' - f ��- nati/man /unkn)
❑ PWS
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no
Type of Project/ Activity
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit**
Application Fee(s) Check#
�mit0if6's Printed Name
latgre
Bing Date §xpiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: `I �� M O'be
Mailing Address: H6'6 CNIOA 3 Icy_ SlIorP,S Dr
Phone Number: 52 [I Y)o n _, L4
Email Address:
I certify that I have authorized Josh i')arbt, r
AgenIContractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: (t 1 S I G1 I nj
at my property located at L % lhad (.l i V Sha es Dr,
in Qn-J oW County.
1 furthermore certify that 1 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.
Title
—t Date'
This certification is valid through

■ Complete items 1, 2, and 3. A.wdla
■ Print your name and address on the reverse X❑ Age
so that we can return the card to you.
�MrAdc
■ Attach this card to the back of the mailpiece, B.n ed m C. Date of [
or on the front if space permits. ,Pr 9 ()tJArticleAddrdssetlto;D. ss different from Item 19 ❑ Yes ivery address below; ❑ No
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3. Service Type
❑Atlas Signature
❑ PriorityegMail Express®
❑Regist Ma Mall^"
9590 9403 0208 5146 7 410 58
❑ Adult Signature Restricted Delivery
o Ceeineedd Mali Restdcted
❑ Registered Mail RasMcted
Delia
Delivery ❑ Receipt for
❑ Collect on Delivery Merchandise
❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmationm
2. Article Number ((lanS(er from service /ahM
_ 7019 0700 0002 3466 5280
a0
ail Restricted Delivery
❑ signature Confirmation
Restricted Delivery
PS Form 3$11, Apri12015 PSN 7530-02-000-3053
Domestic Return Recelpt ;

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In

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to & I' py\6 1 )e.i1 n&o, N ry, 's
rr 1 _ (Name of Property Owner)
property located at FJ'7 C-Y 1(at lAi ((
(Address, Lot, Block Road. etc.)
on 6�l��cQ Cr-r (' K in SnPCYC� t'1 U I Dh.51DLt A , N.C.
(Waterbody) (City/Town /or County)
The ap cant has described to me, as shown below, the development proposed at the above
loca i
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
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 riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
Kel c
Si na*
TI tureKr l I
Print or Type Name
4� ChraclWlC hortS
Mailing Addres�s
Sila (f I K YYU IV C- , 4 b 6
City/state/Zi
9T�1-o-190
Telephone Number/email address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature`