Selton, Christopher

CAMA / ❑ DREDGE & FILL No. 74922
,. A B C D
GENERAL PERMIT Previous permit#
61 fil,�edby
Iw,❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issuedAs autho the State of North Carolina, Department of Environmental Quality
and thestal Resources Commission in an area of environmental concern pursuant to 15A NCAC
.. _ . ❑ Rules attached.
Applicant Name j ( 1 1 ) Project Location: County
iL -- --- -
Address / f � ' %J _ _ �treet Address/ State Road/ Lot #(s)
City I i.-! /( State ZIP - -
i.�rd
Phone # (j
Authorized Agent I)II
Affected❑CW DEW
AEC(s: 00EA ❑HHF
❑ PWS:
ORW: yes / o PNA
Type of Project/ Activity _
Fixed
Floati
Finge
Groin
Bulkh
Basin
Boat
Boat
Beac
Othe
Shor
SAV:
Mora
Phot
Waiv
E-Mail
LVTA ❑ ES
VWrS
❑ I ❑ UBA
❑ N/A
yes /no
Subdivision -_
City- - -
Phone #
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
r
River Basin
(Scale:
(nat /man unkn)
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A building permit may be required by: kL//�-`f / /f!/(. J
( Note Local Planning Jurisdiction)/ /
Notes/ Special Conditions `P- t y
f1.41—
(
Agent or Applicant Printed Na a !/J
Signature '"Please read yompli5nce statement on back of p C rmit`�`*
/
Application Feels) Check
l/. ❑ See note on back regarding River Basin
l:
Permit Officer's Printed Name 1
Signature l
Issuing ate ' ' Expi�on Date

AGENT AUTHORIZATION FOR LAMA PERMIT.APPLICATION
Name of Property Owner Requesting Permit` 0 A'{CS 4L'r
Mailing Address: 2 �a 6 3--C
Phone Number: L v5- 3 — Y O E-&
Email Address: ('' )'j 0ye-�'''
I certify that I have. authorized
to act on my behalf, for the purpose ofapplying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at S
in _11AcrLf County.
I furthermore. ceffify that_I am authorized to grant, and do in fact grantpermission 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:
Signature C /
Prin or �Type Name
Title
s I /l l/
Date
This certification is valid through 5 l_l ZJ
RECEIVRO
MAY 2 8 20i9
DCM-MHD CITY

ADJACENT RIPARIAN pgopEgT.y OWNER STATEMENT
I hereby certify that I OW11. PtOPOrtY 4djqcent to --CL(ish V 52t e"
rty located at Norini 9f Property Own I
property
WSMAI.Ave - L4 '84 MILIhr, Ba-r!, W
(Adi
diii*, 16� 13lo6k, Rood, 4"6.)
"
iri62hVe N.C.
(WatetbodV) , I . a
q (City/town and/or Counto
The applicant has.0ps.crib
d.d. to M-6, as sh�vvn below, the.development propoi;Eid at the above
on.
have no objection to this proposal.
I have 0*069s; to this Aroposol.
OUR filfin ct"off0t(on below or aftch a afte drewIng)
V?'
I unverstand'ineit ' a pier, dock, iriooring% I R, briakft or groin Li
back a rhinifrimni'dlis I I . . , 0 llh*q .. 4 A, . (or' boathouse, groin
ffofn -riji,arpao. para. access unless waived by me. (if you
wish to wilvd.the.igib.ack,you must a0ro . n U ffi��tho. Odle blank below.)
MAY.2 8 2019
dowsh.tooye.ft 16'setback requirement.
DCM-MHD CITY
dq not wish to.walve.the 15'setback requirement.
rmr or IYPe Name
Ivralm L�.d r,"8
qylbtate7Z(p
TeMphon? Wmb�er
DaU
Owner Information)
(Re vfsed VaI2012)

ADJACENT RIPARIAN PROPERTY ON/NER STATEMENT
0
I hereby certify that I owri. property adjacent to inn s h .pi e� l e s
property S 1 t .. l a 4f Propert Owner)
located at ,� s�, (lv c (, L? y
f�l I�Ic�� Sic
(Address, Lo Slock,.Road, etc.)
on � 9Aoi 5,9,4. m :. 1 k eO
(WaterbedY) (City/Fowrr ancUor County)
.
f� The applicant has described to me, as shown below, the. development proposed at the. above.
1 location:
�1lC f have no objection to this proposal:
I have objections to this proposal.
DESCRIPTION qND/OR DRAWING OF PROPOSED DEVELOPMENT:
(Individual pr. oposing development must fiti'In description below or attach asite drawing)
CI�
ID e�
VW .
dam �
�.
W. VER SECTION.
I unders#and that a pier, dock, mnoormg pilings, bfeakwater, boathouse; lift, or roin must be set
back a minimum distance of'f5' from rriy area of .npanaii.access unless waived by me. (If you .
w 1 vvish to waive The setback, you must initial the appro�rrate blank below.). RECEIVED
r ;
A 1 do Hash to waive the 15'setback requirement. MAY 2 .S 2019
I do not Hush to waroe the 15'setback requirement, DC►VI_MHD CITY
(Property Owner Infortnatioh) (Adjacent Property Owner Information)
Af
Signcfty� Sr aiure . `,
CAP
III) V ON tk
Print orly e Name j Punt or Type Name
J L�
9Y31
8Y/State7Z'ip
K) r. I k4, s3� �suzsd
Date
(Revised 6/18/20f2)