Stanley, Mike

�❑CAMA / ❑ DREDGE & FILL CiY (G' No 78479 A B D
G ,NERAL PER 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 Corn
jjjnnnIssion irk an ar a of environmental concern pursuant to 15A NCAC l� V
1 ( j ❑ Rules attached.
Applicant Name I /f ? / f/r �� Project Location: County rY I! rw==t
Address (] �,.% ! / / 9 'n Street Address/ State Road/ Lot #(s)
City }�i Statew ZIP Jr� // I
Phone # E-Mail Subdivision
C �.
Authorized Agent City i ZIP F
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PTA
❑ES ❑PTS
Phone# ( ) River Basin
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AEC(s):
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r(at.�jman unkn
❑ PWS:
Closest Maj. Wtcf/Body a� ��
ORW: yes / no PNA
yes /
Type of Project/ Activity
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Finge
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A building permit mayequired by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant rinsed Name
Signa6(e '—" please read compliance statement on back of permit'['*'
i.
Application Fee(s) *t Check#
i //
1. � �ov r ? i'
❑ See note on back regarding River Baslr `rules.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J. Al ICHAiL
(Name of Property Owner)
property located at �7 C L s6o_ 0 ID. 2•
(Address, Lot, Block, Road, etc.)
on S0QA)JD ,in EIMEliA(_O IScG N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
(i I have no objection to this proposal.
I have 4bj-ections to this.pro.posaL_--------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
41 i 60
/328t
�r �
eisr�ol d.A � rS
Seatj WAIVER SECTION _
I understand-.
nderstand 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.
(Propertyrtj�O"wQner Information)
"--
nature!
T. hlt�If At:c. STANc.E
Print or Type Name
'/03 Lo/w COW-i �9NC-
Mailing Address
t�RAcO 15e_i N•c a�5�
City/statelZiP
Telephone Number
/- ZI-Z02C%_
Date
(Adjacent Property Owner Information)
v\kz ,oj�_-
y
W
6 �
Date RECEIVED
(Revised 611812012)
JAN 3 0 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to tit ' m (G tm u STA tiu-c/ 's
7-�,,Ki
property located at 7�j 0 2 SboiJ tJ l� V �, (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on J306U Jn_CMJF2(1E,0 i.SLf' n).G NC.
(Waterbody) (CityiTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio/n. �
—K-- I'have no objection to this proposal
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must H Iin description below or attach a site drawing)
/
t x1,0 t6 i;: gag,
4 c51NO
5eol 0-0
t,
WAIVER SECTION _
I understand 'that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 16' from my area of riparian access unless waived by me. (If you
wish to:waive the setback, ;you must initial the appropriate blank below.)
t Ito wish to waive the IS' setback requirement.
I do not wish to waive the 15' setback requirement.
or
1Jnre
2
U
onyr�ta�e�up
�SZ - 5S9 DS 7eo
Telephone Number
Date
(Revised 6/18yggEIVED
JAN 3 0 2020
DCM-MHD CITY

AGENT AUTHORIZATION FOR LAMA PERMIT. APPLICATION
Name of Froperty Owner Requesting Permit: %51 IplV M lcN/#&C STAn%<-Qi
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
'/63 ch&R(Z Mtjr
, MQ2,gC_D 1,5L£* /V,<, aF57
o zy(.3�ys
E66-0E/NLN'T lDI L2@6:M4/L, G OM
ON
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _/, C /< le C%0/{ /A
at my property located at �1 OZ SoJN v L�l Ue EE2Eg&t) ISLE
in CALTL2 L / County.
I furthermore certify that 1 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:
signature
Print or Type Name
E2
Title
OIl�l ZD2v
Date
This certification is valid through / / RECEIVED
JAN 3 0 2020
DCM-MHD CITY