Browning, Joey

&AMA / ❑ DREDGE & FILL N9 78426 A B D
ENERAL PERMIT Previous permit# V
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit i sued
As authorized by the State of North Carolina, Department of Environmental Quality , C j(.'.
and the Coastal Resources Commission in a area of environmental concern pursuant to 15A NCAC / 1ty
❑ Rujes attached.
\\ / IJ 1'lJ
Applicant Name J i (J / ^ / ^ Project Location: County C �` !'"
Address 67)6 '&C'i' f I)i/ IN Street Address/ State Road/ Lot #(s)
City c t / l /I �l State NC ZIP 7 I G� / Z ljj v . ✓
Phone # ) 3� 1 E-M it Subdivision
�r- 7 c
Authorized Agent J " "t � � f 1�%% City �'! r ! f ZIP
7&cw ©-W G] PTA ❑ ES ❑ PTS Phone # ( ) _ River Basin .
Affected OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
❑ PWS:
ORW: yes / no PNA yes / no //
Type of Project/ Activity U x lob
�—
Pier (dock) lengthj2
Fixed Platform(s)
Floating Platform(s) _
Finger pier(s)
Groin length
number`
Bulkhead/f pYap length
avg distance offshc
max distance offsh
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach
Other
Shoreline Length _._/ \.- t
SAM not sure yes no \ -
Moratorium: ` n/a yes h`o
Photos: yes Ipy _
Waiver Attached: yes (no)
A building permit may be required by:
( Note Local Planningjurisdictio Y
Notes/Special Con tion�� j
.�
Agent or Applicant Printed Name
Signature ; y jP(ewe read compliance statement on back of permit
Application Feels) Check #
Adj. Wtr. Body _
Closest Maj. Wtr. Body
A
(Scale, J r
❑/See not on back regarding River Basin rules.
er's Printed Name "-...

NC Division of Coastal Management
Hurricane Replacement/Repair Request Form
Date of Request: a IZ % / 1 q
Property Owner Name:
Address of Property: 2Z � � � Lru�� Dr l ^=rti lam( 1'(�1)C.
Telephone Number: Z Z - 7,6q 7 q fir-/
Type of Work: 1ti t �nU.L 1 � GY si rya Win}
�CD� bow, <✓... �
NOTE:
• The Emergency CAMA General Permit 2500 is for repairs and replacement of water -
dependent structures damaged because of a Hurricane. The replacement, reconstruction
and maintenance excavation activities shall conform to current standards and rules. All
work under the Emergency CAMA GP 2500 must be made in the same footprint of the
previous structure with no additions, expansions, or enlargements.
If any portion of a structure being replaced is within the 15' setback of the riparian line or
access area, signatures of the adjacent riparian property owner(s) must be obtained
acknowledging the notification and waiver of the setback on the forms provided by
DCM.
• Any maintenance excavation or dredging requires signatures of the adjacent riparian
property owner(s) on the notification forms provided by DCM.
Signature:
RECEIVED
DEC 2 3 2 '.9
DCM-MHD CITY

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Ii
Name of Property Owner Requesting Permit: Bw"
Mailing Address: Lau-f' -'re� rre' ('
Phone Number:
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: QUU& d iQaMGa10( 5' X�nn' AuL
-4ro— Sgr;anp -Lk-0 `iv, x 4L'WOU V (6=0"e, 5�-4w4LI'
at my property located at ?ZZ I rlw o Cr' L- T-;r- ti o L J )-'C
in (crlr c 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:
-7� � Signature
Print or Type Nam
�IDrnG OwnL/
Title
IZ t Z3 1Iq
Date
This certification is valid through
RECEIVED
DEC 2 3 2919
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
/� Name of Progerty ner)
property located at J 22/ A-Y1 in a �_�C (X
(Address, Lot, Block, Road, etc.)
on >'lv�Gt�S L ffe-k in fop z 14 I S'/1 , N.C.
(Waterbody) (City/Town and/or County)
The applican has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
I
�y
n,,rrbo� 5
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.)
l� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner information)
0
Owner
c ityistareiupu 2 o
Telephone NuT er
Date � RECEIVED
(Revised 6118 2012)DEC 2 3 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (3 IvKltl I n 1� 's
(NameRf Property Owner)
property located at 7 ZZ I rl Yz ut-5 I CGS yr
(Address, Lot, Block, Road, etc.)
on in PA_ lJC— , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to ion.
1 have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
1
y ur5h
�/�����, (('��v o0(`)
C6' 'fGV\
�tG'
✓ xht/
�rO
C*AIVER 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 Inform tion)
9
/-in tune
Print or Type Name
M� ili`ng Address
M ! I 1yi v)Q
City/Staff! ip'
Telephone N�{tuber,
(21 ZI')�
Date
Date
I
(Revised 611812012)
DEC 2 3 2019
DCM—MHD CITY

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