Raymond, Mat C. (2)

CAMA / iJ DREDGE & FILL No. 74411 ^ A B C D
GENERAL PERMIT Previous permit#
C,INew ❑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 environm&tal concern pursuant to 15A NCAC
I \ \ p Rules attached /
Applicant Name fiY �a_., f i I �( \ ' Project Location: County : j
Address Street`Address/ State Road/ Lot #(s) n
City 1 States; zip
Phone # (1 ,) '.� E-Mail w Subdivision
Authorized Agent ! ; ! ( I l Ci/x j) ZIP
ElCW ❑EW 'C]PTA CES �f]PTS Phone# (W) �v f i RiverBasin
Affected
AEC(s): El OEA J HHF IH UBA El N/A Adj. Wtr. Body 1' 1 _ -(nat man unkn
ElPWS: —
ORW: yes / no PNA yes / no
Closest Maj. Wtr. Body
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Agent or Applicant Printed
Signature *'s Please read compliance statement on. back of permit'*°
Application Fee(s) Check #
Permit Officer's Printed Napier
I
Expiration

ADJACENT RIPARIAN PROPERTY OWjV,I?R STAT-BMENT #01
I hereby certify that I own property adjacent to _ i A k� s
(Name of Property Owner)
property located at _ �tid i s �a r e�� c-F f, , 5
(Address, Lot lock, Road, etc.)
on � g $n of in Tex of C- ar N.C.
(Waterbody) (City/Town and/or County
The applicant has described to me, as shown below, the development proposed a the above
locatiory
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWINO OF PROPOSED DEVELOPMENT
(Irrdiv/dua/ proposing development must fill in description below or attach a s# drawing)
'for°1y a
oat f t
fi on Mb"d
geqwee
Hss 41reojy s'ryn4d We �,, �P �:p�,
owfi betA /a'-s C-we &--fro-tf` LVOW Oft
WAIVER SECTION .571ft, Ot r'r*4ar-1
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin
back a minimum distance of 15' from my area of riparian access unless waived by
wish to waive the setback, you must Initial the appropriate blank below.)
I do wish to waive the 16' setback requirement. W /A
I do not wish to waive the 15' setback requirement.
(Property Owner
l
- - ---- WC
Telephone Number
cA4&cf; arks /LG�S aSaasrr 3s9
Date M iNtEO Sander Frerd • Cer✓t
gtigilf
-7T y�ol
30/10 39Gd p�oj 5.40pueS
(Adjacent Property Ownet
Address
I4A
keg"c e y
r �yetol l•-a
KS
nust be set/ "
me. (If you
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)ate
(Revis d 6/18/2012)
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T6ZV6LV016 M9£:60 5T0Z/9Z/L0

I hereby certify that I own property adjacent to to/J • '9
(Name of r�e.y Owner)
property located at {4Lf�y �dii^
(Add ess, Lot, Block, Road, etc.)
on r //�1 2#&f ,e; SD,Aj in r� Le Cae-"--efi. N.C.
(Wateibody) (Cltyliown and/or County)
The applioa as described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal,
I have objections to this proposal.
DESCRIPTION ANDiOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must till in description below or attach a site drawing)
F/%
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of M from my area of riparian access unless waived by me. (If you
wish to waive the setback, you must initial the appropriate blank below.)
----�Ido wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback
(Property Owner Information)
_�6Ae� �
Sign��K
Print or Type Name
IVj,,ei-A Sf.rnC D,Tf
Mailing Address
7Z.
City/State Mp
Telephone Number
cs,vf4t?'&1t t/h S5 )-s.)L- Y3ST
Dale
(Hb-11
Mat C _Red MPA4(
910-7g�rNro
E0/Z0 39dd paod sJapues
)ng4 Owner Information)
sn jJ L Z d 7=
nber
(Revised 6/1 &2012)
TZZDBLb016 WdET:60 510Z/EZ/L0

Pia.n Eno- OJOI;Ay
�[�dd ifiel beat
NO /�oyat lance
Ca/Ie Car¢e�etNG. 165��
/Y►a+- Ro-,V()i an of ITT—
Owes lots;
! pa., i0o /SoguP la��
/ 0 a. /30yeAe I&A-e
116 Fig
3 frW iO4
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.Fr,M 5{0,fe f
P�dPci+y
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: n &4- C k ft /140/. a
Mailing Address: 10,0yi-064A.e lots-t
0ac4h.s0nu.(IP Ale d-C 5
Phone Number: �410 — -7$7 — yl 0
Email Address: MXvP'G /'a.c.,Aoft t� h2 V-Aka0 , t eM
I certify that I have authorized M t e /?, Cr(rs
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: /'Sp 02rAf r^ eA-10-i -5
der.k
at my property located at /,D 0 139 MI j &A C Ca,,U
in Cs.- kr.ad- 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:
Sign
iLat�rr,.�—
Print or Typof Name
Title
Date RECEIVED
APR 2 2 2019
This certification is valid through I I
DCM-MHD CITY