McLawhorn, Jacob

��-ICAIVIA/ El DREDGE& FILL No. 75740 A B C D
GENERAL PERMIT Previous permit #
New DModification ElComplete Reissue ElPartial 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
0 Rules attached.
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nature Please read compliance statement on back of permit
Application Fee(s) Check#
Permitoffiler's Printed Name
Signatu
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
-• :•
JACOB McLAWHORN
GRIFTON, NC 28530
certify that I have authorized DENNIS & SONS MARINE CONSTRUCTION, LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
INSTALLATION OFAPP. 164' OF WOODEN BULKHEAD
at my property located at 1635 TINY BRYAN ROAD
in C CCp\; e i� County.
I 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:
Q-�" ri, M
int or Type Name
it1
-� 1 ��'
Date
This certification is valid through 12
31 1 2019

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property located at
Owner)
I
on N(? as(_ - , in Ha.-e1CX'.K/ 0,1_6ye( ) , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatign.
✓ 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.
(Property Owner Information)
Telephone Number/email address
Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 5 AcoB Kkv I- tyVAADR-tJ
Address of Property: 11p3 'nmY i;PgmA RokfD CR..NVEO
(Lot or Street #, Street or Road, City & County)
Agent's Name #: WILLIAM DENNIS
Agent's phone #: [phone]
Mailing Address: 109 SEAHORSE DRIVE
BEAUFORT, NC 28516
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.
C 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.nccoastaimanagement. net/web/cm/staff-listing 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
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 initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
Signature
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Print or Type Name
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Mailing Address
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City/State/Zip
Telephone Number/Email Address
Date
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Print orJ'ype Name
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Mailing Address
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City/State/Zip
Telephone Number/Email Address
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Date
(Revised Aug. 2014)