Kare-A-Lot Development, LLC

LAMA / ❑DREDGE & FILL �- '' ' ` �' / No. 75961
`QENERAL PERMIT Previous permit#
LiWew ❑Modification ❑Complete IC¢issue _❑Partial Reissue Date previ; us pert
As authorized by the State of North Carolina, Department of Environmental Quality f
and the Coastal Re ources Commissj n in an are 'of environmental one r �trsuant to I SA NCAC
Applicant Name ' + '' /! r ! G �, l ' Project Location: County
Address r �( �� I (1 A� 1 l 11-�'? �.c, Street Address/ Mate Road/ Lot #(s)
City ( ( l StateZIP�
Phone # CE-Mail
Authorized Agent
�i
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑P S
ORW: yes / io PNA yes /)
Phone # (I(fl) V
Adj. Wtr. Body
Closest Maj. Wtr. Body
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Ag o nt r Applicant /e e I ant Pnntl N/y/
Signature "*" Please read coopliance statement on b ckofpeer(mit"*
7
Applit-ation Fee(s) Check #
Permit Officers Printed
Date

J)bw � Cu/1
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: We' -A- 4 eocky143411-C
Mailing Address: ZqW ka�i S el rDvt-.
Phone Number: W j`l ` r�a e5"
Email Address: 2 ?6NO L
lJ �
certify that I have authorized uC �GuE e-( Vjce nvt,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: k6Kilw &its✓-" Am...c
l�ocl� BQIKGeo..P
at my property located at bi/ y�L �( Ul e� Uus-
in C•otfi!Z�jL 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.
Owner
1 yo ("lLG('-e—c`i6 kcrrkrG:
Print or Type Name
hya—a6w�&r
/ p vv Title
O
I I-11
Date
This certification is valid through 1( I I / 20 Z9 RECEIVED
DEC 0 2 2019
DCM-MHD CITY

99RTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. Ocf lk t: Ok T)Ctf, tl ;w,•^LL C
Address of Property:
(Lot or Street If, Street
Agent's Name #: dl., ll*t,' A,y�
Agent's phone H: 1S?-Soy -o 73 L^
Road, City & County)
Mailing Address. 00 A?"Y
A65* , Ga 1tC ZItJT% _—
I hereby certify that I own property atipcent 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. Ldescri lion or <lrawin with tlfmcns Qns n_iusf_t�a provided with This letter.
P( __yI have no objections to this proposal. I have ohjcctions to (his proposal.
If you havo obfootions to what Is being proposed, you must notify d,o Division of Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Contact information for DChf offices !s
availabieat:/hrr»v.nccoasr,-rlmanaaemenr.rreihveb/crNsraff_llstingorbycalitng 1.888.4RCOASL
No rasnonse rs Mnsidarod thn en.nn n�.,i,r.,,.,:...,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance or IT from my area of riparian access unless waived by me. (It
you wishtowaive the setback, you must initial the appropriate blank below.)
fArK I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Property Owner
Signature
b Ybl" pL'dt o-(6rr:c
Pnn or Type Nano
Idenm'q7 Ad dross
fa"rrar:,i�/zs,
(Riparian Property Owner Information)
Z%we
.Vgnmrfre
Prial Or Type Narne
r A, e�1 1f1L11
Mailing Are dwss' /
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( rr fr rood AJ h„sr:
�% r !• f �l p/►►ccyp�/�D
J1rru.nl Aiu7 i'r]}31
DEC 0 2 2019

a
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: 2QU �L� V 1 e,,D 6�rk
D (Lot or Street #, Street or Road, City & County)
Agent's Name #: B/u-e Mailing Address: 000 140I< f-T
Agent's phone* Z0--Soy-0737 � A/ 4if If z8,rr7
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 desgr'ytion or drawing with dimensions must be provided with this letter.
Gp� I have no objections to this proposal. I have objections to this proposal.
if you have objections to what Is being proposed, you must notify the Division of Coastal Management
(DCM? in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at ement�nethxeb/cm/sfafflistir ,orbycalling 1.888-4RCOAST.
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
youwish to waive the setback, you must initial the appropriate blank below.)
4'4) ) - I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner
Signature
Print or Type Name
22t(41" k'e-'s
Mailing Address
��•� ,
City/State/Zip
Telephone Number/Email Address
Date
Information)
or TJoe Name
'SVS� 0 V� PA14- pA .
Mailing Address
City/StatelZip
: 5Z - 5Z)- SGS7
Telephone Number/Email Address
� Jt�r/�rq
Date i RECEIVED
(Revised Aug. 2014)
DEC 0 2 2019
DCM-MHD CITY

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