Upchurch, Robert

®CAMA / ❑ DREDGE & FILL No. 75966 A B C D
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue [-]Partial R&'4u Date previous permit issued
As authTrized by the State of North Carolina, Department of Environmental Qua ity /�i - !l IeT
and the Coastal Resources Commission in an area of environmental concern pu uIt to 15A NCAC r` `^ t -ram
` Rules attar ed.
Applicant Name _ Project Location: County f
Address Street Address/ State Road/ Lot #(s)
City __ _ _State ZIP
Phone #
l! Authorized Agent
Affected OCW ❑EW IPTA ❑ES OPTS
AEC(s): ElOEA ❑ HHF 1 ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /(nb j PNA yes /
Type of Project/
Pier (dock) length
Fixed Platform(s)
Floating Platform(
Groin length �
number —
Bulkhead/ Piptap length"
avg distance offshore —'
max distance offshore---!
Basin, channel,
cubic Yards
Boat ramp
Boathouse/ Boatiift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Subdivision
City_'l.+j i 1—
. ZIP
�—
Phone # (j l 1 / ,River Basin
Adj. Wtr. Body___ : gnat /man /unkn
Closest Mal. Wtr. Body
� 1
0 41 I1
_..d0 >
Moratorium: n/a yes no
Photos: yes no —
Waiver Attached: yes no I
A building permit may be required by: Il) ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conciltions ' �. "Yi
'�Z Z/
f ;
Agent or Applicant Printed Name Permit Officer's Printed Name +
Signature ** Please read compliance statement on back of permit Signatur
i,fiU ��Iv�oao
Application Fee(s) Check# Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Z&eo— Jb', A(p,- dzCRc y
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
�l l �9edY��j9-lwyN
%PPACYr,,40 C=I7y, PJG �,33-7
CXa-a y-;7-- 19'-�
& y v t- �f/Y"�
a/u e Aw /<S
I rraCor I
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in ✓ lC7c"%k_County.
I 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:
t-gignature
P86o - A l e#y ',
Print or Type Name
Title
2-2—1 c7V/9 RECEIVED
Date
DEC 03 "big
��
This certification is valid through ! l�l DCA4-MHD CITY

I hereby certify that I own property adjacent to
Property located at Syr �� �- ,�7 (Name of Property Owner)s
on 'G TEjz uCG K is d dr L ®lock, �cgaa etc?
in i 2a IcKi�d ��, L��
(Waterociay) N-C.
(City) owrr and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to at' nj
I have no objection to this proposal.
I have objections to this proposal.
vdv�rrs�B"I SUN ANDiOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
SECION
I understand that a pier, dock, mooring pil ngs 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.
(ProPe►ty Owner
�fInformation)
St
�re,�t i� u�ryu/CC�I
Print or ype Name �/
)'1)GDrt6r4 in6E
VI icing Address
l-eitlyState/Zrp ! �,�
.1 A /F7014-"'46(r �r 4� /, ors,
ea „1G wunmerI email address �0?1
(Adjacent Property)) Owner Information)
"Valid for one calendar year after signature` (Revised Aug. 2014)
RECf�IVE (s
DEC 03 IM9
DCM-MHD CITY

--
RECEIVED
DEC 0 3 2019
DCM-MHD CITY

S7_
RECEIVED
DECO 3 1.
DCM••MHD CITY

I hereby certify that I own property adjacent to
I
(Name of Property Owner s?
property located at Ar �_ ,41le /�i3�tt_ii{� A,
,Address ddress, U Bloc , Rgad etc. �G
on '�k (1rC K in 01, zed ��i . N.C.
(Waterbody) (Citylrow and/or County)
iTheappli nt has described to me, as shown below, the development proposed at the above
F� I 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)
oeC% 11V7)Wgde1) Xa#741`/ /✓G- I
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.
(Props Info (A ac t P party Owner 1 Zfor on
Si t e
si �e�r !� PCHuRC�I St`yM
Pnnt or]ype Name
Date
C
address
er,
*Valid for one calendar year after signature`
m nrng Hooress • ,
�i1AM Ci %v A/G 2g?5,t 7
(Revised Aug. 2014)
RECEIVED
DEC 03 2ui9
DCM-MHD CITY

�j �
yam.
f
rb
N
v
RECEIVED
DEC 0 3 W9
DCM-MHD CITY

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2I Il 1 I 1 I I I I�
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` RECEIVED
1 ( � N DEC Q 3 91019
DCNl-MI-iD CITY