Schneider, Joel (2)

L CAMA / ❑ DREDGE & FILL No. 75240 A B C D
GENERAL PERMIT Previous permit#
[/]r flew OModification ❑Complete Reissue El Partial Reissue Date previous permit issued
As auth, 'd by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCACCvl:
(`Rules attached..
Applicant Name ' Project Location: County
- --- r
Address Street Address/ State Road/ Lot #(s)
City
State ZIP
Phone # i
(? E-Mail
Authorized Agent
Affected '❑CW LI EW GPTA DES ❑PTS
AEC(s): ❑OEA ❑HHF ❑IH ❑USA ❑N/A
❑ PWS:
ORW: yes /,no PNA yes /no
Subdivision
City ZIP__
Phone # O - River Basin
Adj. Wtr. Body _ _ _(nat /man_/unkn)
Closest Maj. Wtr. Body _
■■■■■■■■
■■ ■■i■■■■■�, !'/I�11�I■■ MMOMMEMEMERENIFIMEMEii,! ■■■■MEN ■
■■■■■■■!■■■■■■■■■11■■11!.d'■■■■11■■■ii■Pi9111if/.MEN
■■u■■■■■■■■■■■■■■lid■lL7
r.■■■11
■■■■■.�■lm
■a■■■■■N
■■M■■■■■E
■■■■■■
■
■
■0■■■■■
�■■E.■■■■■
lorliYl�■■■11IMMEM
moil-
ii®.■■I.■■■!■■
■■■■■■■■■!■■.1■■■■MUM
.IFS'®■■■.■■■■■■■■■■■■
::::::::::
ME
101::1�C:►::::
■■■■■■■■■■■■■■■■YG�
■■■■■■■■■
■■■■
iu
■■■■■■■0■■11■■■■■11■!!�io■■■■■I■■■■■■■■■■■■■
C�■■!■■.11■■��
■■■I-�
■■■■�■
■■■■■■
1■l(1■■■■11■
■■■■■■EM �19R�:
u■ ■■■■■■■i
■■iMEN ��n■■■■■■1■■(� 'I/■■n■i0■
■■■■■■■■i■■■■■■I.■. wo.■■■.'.■■■�■■■■■ME
SEEN !<IIfi1l���.I!■■!■!S■■��■
■■N■■It■■ ir■■.1111®®
!!..r^.;IA■■■■■■■11■II■■� G
■■Ia1.■■■ !■/1■'11■■1�■lif`■■■■■■
!!I■■EM i���'1■Y"Y■11!
�� ra
..■■■.■.
C
■:NEso
E
EM.
:
NO
NEE
■■■N■
MENEM
■!■
{{{{..■■...
.
■
NEE
■■■■�■■
Agent oh Applicant Printed Name
Signature"Please read compliancestatement onbackofpermit**
Application Fee(s) Check#
Permit Officer's Printed Name
Signature
Issuing Date Expiration Da—�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1, o n ! U�� e : vL r 's
/ (Name of Property Owner)
x
property located at Q.,r, e f / oIC
(Address, Lot, /�Block, �R/yp/ad, etc.)
on �"��, �e�i� , in .CJ ' ; - / /l/C N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
7) 1 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)
p�plo-c-e _e' ::6 "tN� dt94 Y Iu5 pdA,t(oa
r
06 x
-ro dock
5
i3 X8'Cw '
WAIVER SECTION
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 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)
Si�ature /
Print or
� Type Name
6 re3
Mailing Address
�.:.
City/State/Zip
Telephone Number
7/..>t/l0)'>i9
Date
(Adjacent Prpperjy Owner
or
f::�o eo X 6&t
Mailing A dress
"dk4rr0gVr- /yam
City/State p/ 7-.Z4 / Z6 76
Telephone Telephone Number
Date
(Revised 611812012)

ACiJAC1NI" R21 j 8.IAN P8.QPERTY�WNI;f? *TATEi NT
i hereby c erttty that l own property adjacent to .� � ,� � ��� � _. `S
(Nama f Property Owner)
property located at*
tAaCtre59, Lot,Block, Noaq, etc.)
in _f? .tom _ �., UCt ,
M (Waterhody) (CitylTown andlor County)
The applicant has described to me, as shown below, the development proposed at the above
10cati n
I have no objection to this proposal
• J
1 ttQve.ogjection to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual posing development must fill In description below or attach a site drawing)
/1;Xroo' �KrSt+d►g 44ac4 -i i us Ji s�p rYren�
Aok
�t
dtr1411aA13
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 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) (Adjacent Prope y t7wner information)
>'rint or Type Nar»e
26 4,3 G_. t , >4 r, i
Mailing Add s
cayr�srtz eiZip ��
Telephone Nurnb r
---..7 4 �//r�.J/, ._.
Data
7"aioiibone um er .
ree
.1S.

AGENT AUTHORIZATION FOR LAMA PERMIT. APPLICATION
Name of Property Owner Requesting Permit: �o I
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
F/ 9— o? S'/ — 9'" 9
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: c
at my property located at e1663 e/ _
in Ca.«cf County.
c -P•-,
1 furthermore certify that l 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:
­A;wature
TC-i S_417ML.•e_l&.
Print or Type Name
Lam-.
Title
Date
This certification is valid through _ 7 1 a 7 1 102 a
RECEIVED
SEP 19 2019
DCM-MHD CITY