Biedenbach, Paul

AMA / ❑ DREDGE & FILL O
,.. N . 78464 A s � D
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality -Al
G,'
and the Coastal Resourc om issionlh anare of environ ental concern pursuant to 15A NCAC
/ 1/) ❑ les attached.
Applicant Name I' t �% l ��'� > Project Location: County
Address i L", Street Address/ State Roa Lot #(s)
City I:/l " .�U� l State"( ZIP, �'✓ (L i bra (! r
Phone # ( M it Subdivisi r j r
AuthorizedAgent )<.-t` _ 1•'��r)-: \ City A ri r� ZIP 1�1�
❑CVo PEW PTA El ES ❑PTS Phone ( ) ve Basi U
Affected U OEA ElHHF ❑ IH ElElUBA N/A
AEC(s): Adj. Wtr. Body n i man unkn
❑ PWS: Closest Maj. Wtr. Body '
ORW: yes / no PNA i'yes)/ no
Type of Project/ Activity 6 &19 CiG t' F
/ > K / S /, 1 y" (Scale: /(/ / f )
Fier I
Fixec
Float
Finge
Groh
Bulkt
Basin
Boat
Boatl
Beac
Othe
Shon
SAM
Mor
Phot
Waiv
A building permit may be required by: / CY �`�� -_"'� t U See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions / / I !rr �;...'-, `.i L f / —`•,
Agent
Name
*'* Please read compliance statement on back of permit *'
Fee(s) Check# Issuog Date
0

AGENT AUTHORIZATION FOR CAMA PERMIT.APPLICATION
Name of Property Owner Requesting Permit: Po,) D. B;edt.,&c,
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
ZSO �ivrl &ec.k Lane
.Swag baio Ajc Uj(?q
9H zis 97s7
Agent
i . 6"
,Statoas7
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: le P14tt C111 of _
at my property located at Z-S-0 R;vto, C/eek Z4AC.
in 64i1<ie7 County.
1 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:
7 Signature
Print or Type Name
Title
QLI if / ec Zo
Date RECEIVED
JAN 2 3.2020
This certification is valid through O6 / 30 1 Zazo OCMOMHD CITY

ADJACENT RIPARIAN PROPt IRTyY OWNER STAMMMENT
1 hnreuy fettNy that i Owe, IIrOUCtty adJacenl W _ T'p � �e �eflC�Rr±r.•ry --..—
(Name of Property Owner)
to utxriy Mz:ated at ZSO Rlvrl OreL la 4__ _ -
(AddreSS, Lot. Ulmk, Read, cm,)
UP *414011 cleek..._ 1A S«�a N (:
(Waterriody) ptyiTown arW oT Countyj
1h: apptc:urt flay deswxr tl to pie. as Shown baaw, 0,0 JO&IOr 'em prnpo sr.d -it the rlt:ovn
klwtwn_
I have n0 xhp?ah,n k'7 IhIY prat 1s,u
? hpYV pI>(CLIio:.y f0 {)PSI rv?pV>A{
DESCRIPTION ANDIOR DRAWING OF PRQPt7SF..O T1fVE ©PMENT
fln&Odual proposing development must fill ire description below or aftach a srtc drawutq)
eXA::1 clack
InJla�� AM� ti fi� i r� s A� a
AWOR-11U, AM
i 1•tKl Dstafld liar a p,e't oock, 11)u Ijly [.vlulga, braaKwitvl L%ith laa0 Aft, q :het m,al h: o-el
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610, m wa vh tar• stabn,.h. ycu must Initial !roc appl oer•at,: sank w1uw I
Jo'MYh Ir; Wall, Ity 1!" •AIl1.M.h trMUINIM0111
i do not wlbh !0 w.1kVv ll`a: 7 5 5.'tllJd, ltrytWPMqu'
(Propntty Ow?net tpfo�mmtati nj
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RECEIVED
JAN 2 X 21U2U
DCM-MHD CITY

1/16/2o. 9:60 AM
CAMA.Ipg 1,2640,762 pixels
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
S
I hereby certify that I own property adjacent to Ya
(Name of Property uwnur)
property located at Z50 Lri Gak /'2
(Address, Lot, Block, Roadetc.)
, N C
on �eo(Ao� ��uk in enlbeio Ca/�iri �^c_�y
(Waterbody) (City/Town and/or County
The applicant has described to me, as shown below, the development proposed at the above
I lion
I have no objection to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
� pIAQAfAJ of ,perxJil� Jack
In11•]l �l 10
J /
arid('
/ � V
WAIVER SECTION
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 wave the setback, you must initial the appropriate blank below )
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Ad' ce�Property 9 ner Information)
aI // Sznanire gna UIT
liar I 1�iC(�tniaac� ��ri
Print or Type Name print or Type Name 1
//s «✓fin,✓7`IIPL-S �J
Address
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Number i eiepnu ra
Wo ` r7
Dare
RECEIVED
hope://webmall.spectrum.net/indox.php/mall/viewmessage/getatta...Original/CAMA.Ipg/flenameModified/CAMA.Ipg7tolder=SU5CT1 g%253D Page 1 or 2
JAN 2.1 2020
DCM-MHD CITY

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