Bishop, Shelly

❑DREDGE & FILL N. O
P� 78445 A B C D
ENERAL PERMIT NN Previous permit#
flew ❑Modification ❑Complete Reissue []Partial -Reissue Date pre'ious ermit issued
As auth rued by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Comm'ssion in an area of environm tal concern pursuant to 15A NCAC j t•l -'i t ��
' � Rules attached;'
Applicant Name Project Location: County . (y'
Address
City ✓Z loj �� State ZIP
Phone # (�E-Mail
Authorized Agent �) \
Affected CriCW b'EW (TA ❑ES ❑PTS
AEC(s): ❑OEA ❑HHF ❑ H ❑UBA ❑N/A
F PWS:
/max,
nRW- — / nn PNA vn< / fin
Agent or Appjca Prmt Na
-f ' _
Signature `s' Pleaseread compliance statement on backofpermit"
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body' / ,' / I ��, . _ _ (nat /man unkn
Closest Maj. Wtr. Body_
Permit Officer's Printed Name r/
Sign ure
Sign
5h31Q,a6
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: SAE L U/ Ql S/ r o P
Mailing Address: 2 ZC) l 1/F�L E / 6:14 L 4-ry F
Phone Number:
Email Address:
I certify that I have authorized
c l/dzle�SOAJOle, bF /clG 7rgAl o
She br 01 09q��.Cd•�
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA ppe�rm�its�,�% 1
neces ary for the following propo d development: �`e � �� ��`-C Zati
/� - d^
at my property located at
in CtrrrGMP.�i/ — County. GIP,C Ctir / 2t5F-'
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.
Property Owner Information:
RECEIVED
JAN 14 2020
Sig ature
DCA4-MHD
CITY
Print or Type Name
JAN 14 Auto
pCm-mwC CITY

V)
RECEIVED
JAN 14
DCM-MHD,`i"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � rt: r3i -�h s
(Name of Property Owner)
property located at �d� � I �
(Address, Lot, Block, Road, etc.)
on %Z� ii�� 2L4 GPGGIC in r mil=' Cf� .Q7Y �Y.`^ . N.0
aterbodvl (City/Town and/or County)
The applicant has described to me. as shown below, the development proposed at the above
to a ion.
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)
WAIVER SECTION
understand that a pier, dock. mooring pilings, boat ramp, breakwater. boathouse, lift. or groin
•nust 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.)
1 do wish to waive the 15' setback requirement.
,4\ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sig»nrare
/(Adjac ."'e7ow et Information)
it2ncr u•¢"
,rnct
RECEIVER
JAN 14 2020
DCM-MHD CITY

n
ADJACENT RIPARIAN PROPERTYOWNERSTATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at t: 1.0
(Address, Lot, Block, Road, etc.)
on RO C,K4 / tLw G at:; C in l'A-pr= C A 27 ter" N.C.
aterbody) (City/Town and/or County)
The applicant has described to me, as shown below. the development proposed at the above
loc 'on.
4.✓ 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)
JAN 14 Z6,
DCM-MHD CITY
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,
,4�2�/ ` _ I do not wish to waive the 15' setback requirement.
(Property Owner information) (Adjacent Propertv Ownec Information)
1i iralmr S:nur 4-4

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: , /J E�W �" �
Mailing Address: �� !t V �_ E � 6f q �,4
Phone Number:
Email Address:
I certify that I have authorized
J &fi�SOAJOIL t,F AJCf, `705'1 o
�J10 77/o
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
neces ary for the following propo d development: NW at my property located at Dr -(GV +hfSf`�'
in s County. ,q p'e 6rnjey -Z 6S F-4
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.
Property Owner Information:
`l
i
Signature
Print or Type Name
I ` t
Date
This certification is valid through Z / 2� F / -C)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own oroperty adjacent. to s
�,� {Name of Property Ownery
property located at
/ 0-1,
on
iresi-,—Lot, Block, Road, etc
I in
and/or Cou
N C.
The applicant has described to me. as shown below, the development proposers �t the above
id ion.
have no objection to this proposal.
have Objections to this PrOPOsai
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
{ffidlvidual proposing development must fill in description below or attach a site drawing)
W�R SE—CTIOq
understand that a Pie;, Clock. mcO`ng Pilings, boat ra"'P' breakwater, boathouse lift, or 9fo:"I
Must be set back a minimum distance of I
, 5, front my area of riparian acess unless wa,ved 1,i
-lie (If you WiSrj 10 waive the setback you must initial the appropriate blank below
'do Wish to Waive the 15 setback requirement
I do not,.%risn tc,,%a!ve the j 5'setback requirement
iPropertY Owner Information)
,-,7m, -Aj,
,iAdjacent pr,opertyta%"'r intormallum
ype Name
7e%pn"e Nuplemai,

•i
i
PC
t'
t lji
�i
71
T
:V
`k ' JI
^
71
a

ADJACENT RIPARIAN PROPERTY OWNER SLATEMENT
I hereby certify that I own property adjacent to -_. 615-l-hp
s
(Name of Property Owner)
property located at p� ---
(Address, Lot, Block, Road, etc.)
on G C 2� 3 G2 L n _ 4 x� i4 7Ca r —:�_ N,C
aterbodv) (City/Town and/or County}
The applicant has described to me- as shown below. the development proposed at the above
toc oTn'.
rj''2 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 to description below or attach a site drawing)
WAIVER $EC7
I understand that a pier, dock. mooring pilings, boat ramp, breakwater boathouse lift or groin
must be set back a minimum distance of t5' from my area of riparian access unless waived by
me. (If you wish to waive the setback- you must initial the appropriate blank ben N 1
_ I do wish to waive the 115' setback requirement.
A(It_`1 do not wish to waive She 15' setback requirement.
(Property Owner Information)
t I"miaut'
Pruv or Typo Name
Mailing Addrimr,
Crty'ISfate'Op
�,iephor7e Nernrtro, /Wrrad 40fires5
`VaW for one cilerdar year after sgnatt re-
y Owne{Information}
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I
"7} Sr 41
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ir'7e:�seJAog 2014`