Pier Pointe POA, Co James Hoffman

NCAMA / ❑ DREDGE & FILL No. 74457 A B C D
GENERAL PERMIT Previous permit#
bgNeW ❑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
❑Rules attached.
Applicant Name
pp j If'.� �+ -! I tl� L t �-��� � o,t/7 Project Location: County
Address '/.. Street Address/ State Road/ Lot #(s)
City !-n,);�7.� rl State (. ZIPC�,�,
Phone # (__.) I
Authorized Agent
Affected
El CW
AEC(s):
❑OEA
❑ PW5
ORW:
yes / no
E-Mail
MEW NPTA El ES ❑PTS
❑HHF LIIH ❑UBA ❑N/A
PNA yes / no )
✓?/, ZIP _
Phone # OT River
Adj. Wtr. Body t (' '} (Vr(
1//
Closest Mal. Wtr. Body /1' - +
l
OEM
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Beach Bulldozing
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Other
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Agent or Applicant Printed Name
Signature & Please read mpliance statement on back of permit"
1,7
104,4 � -
Application Fee(s) Check #
Permit Officers Printed Name
Signat re -
�'%9/i
Issuing Date E piratioc� n�Dat:e

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: f I'L n, P© I Wf e- OW 0 eRs h SSoc r,���)
Mailing address: le pen �Di�✓
,N,yw ,R-eaA/N
Telephone Number:
I certify that I have authorized T Lnz-S / exe, z/4 2 (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at
/DD �%ch�,ti�ewJ�N Nam. ��,56'Z,
This certification is valid through 14 ",?/ ^ ,eOl % (date).
(Property Owner Information)
Signature
✓ ' A�9 f'r .1/1. Ali�f�n�
Print or Type Name
Title, co. owner or trustee for property
y `/ Zo/7
Date
s, ' re -Zb3Z
Telephone Number
Email Address
at my property located at
/DD �%ch�,ti�ewJ�N Nam. ��,56'Z,
This certification is valid through 14 ",?/ ^ ,eOl % (date).
(Property Owner Information)
Signature
✓ ' A�9 f'r .1/1. Ali�f�n�
Print or Type Name
Title, co. owner or trustee for property
y `/ Zo/7
Date
s, ' re -Zb3Z
Telephone Number
Email Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 00,ram �bi�Tt /'yea Otl- OwnEyeS eye ,
(Name of Prope Owner)
property located at 93 / 44 A /o /n i if X L i/ X2
(Address, Lot, Block, Road, etc.)
on T%l eh % 't v L 2 in Qrv9 A /36 y/il
(Waterbody) (City/Town and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
/`ItT.4LL / %/L rl�y f o/e ,Qolgqr"
MI'e11y1=1CryX44lI*]z
I understand that a pier, dock, mooring pilings, 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 vvNive the setback, you must initial the appropriate blank below.)
�\f I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
S $ll1ature
✓Ah7 trf Gott a Z r K
,e Name
/'7 tWo o tvS
Tress
G,alit'
Telephone Number
s `f
Date
r
nignature
Print or Type Name�d ,_/�lGG�2 �J
Mai 'n ddress
City/State/Zip
.5a-c2 ql'6 s-S
Telephone Number./v / / 5
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 601, 14o L-C of -4t--Y ' 4%XJ4:�6'
(Name of Property Owner)
property located at .33/�%L �ar��°� iGro S-2
(Address, Lot Block, Road, etc.)
on 7-1ff-77i Qtvt/1 , in-/� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
/nsTAGc �4 /-4/G,/mays
r.J/¢TE h
All -A *;Cl=101111[9L`
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distan of 15' from my area of riparian access unless waived by me. (If you
wish to wai he ack, 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)
,w / X4 e-'I
Signature
J-,fAof ?,,egZ/E72
'Ps
Date f"—�7 1%
(Adj ce t Propert wne�mation)
5a
Telephone Number
s-3-�9
Dale
I -le,
(Revised 611812012)