Whaley, Gary (2)

^ ❑CAMA / ❑;DREDGE & FILL No. 73905 A B C D
GENERAL PERMIT Previous permit#
]New ❑Modification []Complete Reissue ❑PartiaPReissue 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 Project Location: County i (
Address 1 Street Address/ State Road/ Lot #(s)
City' l State ZIP Subdivision Phone # ( ) Mail — i
Authorized AgentCity ZIP
``// f
Affected ❑CW EW W`PTA ES ❑PTS Phone# ( -) River Basin
AEC(s): ❑OEA XHHF ❑IH ❑ BA ❑N/A Adj. Wtr. Body_ nat /man /unkn)
❑ PWS;.
Agent or Applicant Printed Name
Si nature 't*" Please read compliance statement on back. of permit"
a(X)
Application Fee(s) &eck# "
Permit Officer's Printed Name
S,iigoqat re
is ui g Date xpiratiorfrDat�

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 64 W 14A G Ey
Mailing Address: 3l0 3 r B 0 rs- 120 A -I'---)
n151"o1i �N L Z850 4-
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Dy CK
_ 3ULK4r—Ap Alji> r�93a097'641=t—/nl51"s1-GL-�i'
at my property located at �� r3�+!✓l �� �L�� '
in C r merc-ounty.
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:
Signatur
Gary E. Whaley
Print or Type Name
yys.4V iZ
Title
2 / 20 1 2019
Date
This certification is valid through 2 /_+1_/ ' !_

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to G''M W I+04 L ff,.Y 's
property located at d—'T u V 1
(Ad ress
on 136 ftr-- in
(Waterbody)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
I ati n.
I have no objection to this proposal.
I have objections to this proposal.
WAIVER SECTION
I understand that a pier; dock, mooring pilings, boat ramp, 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.
212 12019
Date
*Valid for one calendar year after signature*
VA
Lei
address I
(Revised Aug. 2014)

z. \ \ \[
----------- --- ----
L

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 6+tz Y W HA G. sy
Mailing Address: 3& 35- 13 i (r- b'-!<' 00A-7-�
k) ej s T0/j ® M C- Ze.56 4-
Phone Number: ( 353 7
Email Address: elm., I i . co�
I certify that I have authorized ikd 2ry ®d pL f
Agent t Contractor
to act on my behalf, for the purpose of applying for and obtail!ning all CAMA permits
necessary for the following proposed development: tom% tA/ pq ><
gVL�� (4-c-jD LE5 /4 S t�ov
at my property located at 2dq rSjVr/! 4/ 1-l✓,::,
in C!4 6f?erc 0 unty.
t 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:
-�--Signatur
Gary E. Whaley
Print or Type Name
�L�-drel � Iz
Title
2 / 20 / 2012
Date
This certification is valid through 1 -
C)/,j

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to \/ pWI-PA L-1f-- /afne s
property located at _ �'T'/1I/ F=-tn% to Mroperiy O
(Ad Mess, Lof, lock A.
etc.) a
on 1315 15V E aa✓7 , in 7�� 8 . W !�C`+"i �, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca(Ian.
;L I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual Peoposing developrnent must fill in descriptlot) below, or attach a site drawing)
AIVER SECTI
I understand that I -pier, dock, mooring pilings, boat ramp, 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.)
Ja �C
sue' I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback'requirement,
(Popert�Jl00 elr Information) \ (Adjacent Pi
Wignalw-e
Gary E. Whaley
S' 77 n x
A A,
Point or Type Name
prints T Lp I
3635 Big Oak Rd.
Mailin Adress
Kinrin. dNC 28504
Mailr, Ad
G
Cit /State/Zi
m_
City/Stgte/TA�,
25y2-521-9537/whaleyl956 gmail.com
Telephone Number/email address
Telephone N�
2/20/2019 --
Date
Date"
"Valid for one calendar year after signature'
- 3U`
M address
(Revised Aug. 2014)

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