Snider, Drew

®�1.'CAMA / DREDGE &FILL NO. 7S%g9 A B C j D
GENERAL PERMIT Previous permit#
New ❑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
I, p( ❑ Rules attached.
Applicant Name j %i�/� r ✓ ) n 7i /C'�
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City / y StateLZL ZIP
Phone # (a)
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Authorized Agent
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Affected
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ORW:
yes / no
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Type of Project/ Activity '
Float
Finge
Groii
Bulkl
Basir
Boat
Boat
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Project Location: County [/ ri
Street Address/ State Road/ Lot /#/(s)
Subdivision
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Phone # O� River Basin 6 :1r''
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A building permit may be required by:
( Note Local Planning jurisdiction) /
Notes/ Special Conditions J
Agent or Applicant Printed Name
❑ See note on back regarding River Basin rules. _
1 !
Printed Name
Signature ** Please read compliance statement on back of permit'°
Application Fee(s)
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Check# Issui Date
l�
cpi atlon Date

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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 10,' e4.) f %Qin,4,ad J^' ; d -c -
Mailing Address: i 7 1 Lora L rL
Phone Number: `+1 �' (' S 3
Email Address: �t✓�cr ���i� ��
I certify that I have authorized L l h t,Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: (C, j/Luc.4
' (
at my property located at (� /uLteS�uttP� C
in CA2k�)--4 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:
-Z -�7-
' Sign- ure /
Print or Type Name r
2LO]4 1 U� ( 4-1
I�I Title
Date
This certification is valid through —M—l_(_t�7d0

'X- i-
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIO,
Name of Property Owner:
Address of Property:
Agent's Name #:
Agent's phone #:
FORM
r Road, City & County) g /�
Mailing Address: 5a'
Din,�,n A)(,,, ail-3
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 drewina with dimensions must be Provided with this letter.
JI have no objections to this proposal. _ I have objections to this proposal.
rave objections to whatlsbeingproposed, youmustnotirytne wwsion or coasrerm=�.,+y=,,,=•,.
In writing withln 10 days of mcelpt of this notice. Contact INormagon for OCM offices Is
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.)
0_ I do wish to waive the 15'setback requirement
I do not wish to waive the 161setback requirement.
(-icL,4 Ltw 0
Print or Type VOMO
5iO Hcubng Oi1112ct
i4feiling Address
&v111z Nc Z7zX�
C PStete?!p
elephoneNumberlEmel Address ao)
P-E4'a f ,-'50 oo IG
Date
(RevlsedAug. 2014)
N6CZ) -I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION)WAIVER FORM
Name of Property Owner. - c-��-t�--�y�- I�,✓�11 �J, -!S�
Address of Property:
— (Lot or Street It, Street or Road, city & county)
Agent's Name A. Mailing Address:
Agent's phone #:
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 descdolion or drawing with dimensions must be provided with this latter.
0 I have no objections to this proposal. _ I have objections to this proposal.
If youhave objections to what is being proposed, you must notify the Division ofcoastal Management
(DCM) In writing within 10 days of receipt of this notice. Contact Information for DCM offices is
availableathhH:/lwww.necoastalmanaoemenrnellweblcmistaff-listi aorby calling 1-SM4RCOAST.
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
_�----�{Pi o1 el ypyri In ormaHop)
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Print or Type Name
�l1P,
3� Yir-o�
l0Y2 q�9
Mailing Address
0000
City/Slataop
Telephones Numbberl Email Address
Dnlc �
(Revised Aug. 2014)