Cogrove, Bruse & Edmondson, Cal

1C4WA / ❑ DREDGE & FILL N9 78436 A B (�C D
ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit
/issued
As authorizedly the State of North Carolina, Department of Environmental Quality / ptjt J
and the Coastal Resources Commission in an area of a Mir nmental concern pursuant to I SA NCAC / I
� ❑R les attached.
Applicant Nartte�w ��)%�S Project Location: County Cry
City '' < c !7 t State ZIP 2--%6 `/
Phone # W) 4tf /— / ' E-Mail
Authorized Agent
� --f �PTA
Affected If7rcw
AEC(s): ❑ OEA
❑ HHF ❑ IH
d�WS:
ORW:/-"Y-,s )no
PNA yesic
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap lei
avg distance o
max distance
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length I / k /l /
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Ze- t"ee, K
El ES ❑PTS
❑ USA ❑ WA
o 77777
JV xis
11-Y
_ I-Awlw,-(4
Agent or Applicant Printed Naaf"r6e'
Signature " Please read" compliance statement on backof permit'**
Street Address/ State Road/ Lot #(s)
137 ,' 'T3ly ,JPr
Subdivision
City ZIP ad
Phone# O ver Basin t'
Adj. Wtr. Body tr^man unkn
Closest Mal. Wtr. Body C �"" ,4 ✓!
(Scale )
❑ See note on back regarding River Basin rules.
Ll
(fj`ApplicationFee(s) Check# + Issui Date Expirati nDate

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to u.c e ' crl �,_'s
Q // (Name of P perty Owner)
property located at 6 r� 2 c'- d
(Address Block,
on .dr�G,in =)
C C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I p2nve objections to -this proposal- .-- ---
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
eJ L n , r jb yv
5V
Gk,-_ _ '0rWAIVER 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.
Inform n)
4)G eAd e,
Date
(Adjacent Property Owner Information)
NffljvkA,&fi t
Se l A J
Print or Type Name
P Ov
Mai g Address J
Oti
OC'�>
vnyroia�ciuN �.
2 2V--=6r
Telephone Num or
I ^q�'1
(Revised 611812012)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAiVER FORM
Name of Property Owner: C-A L ecif t"OKab WA
Address of Property: ` 9 3' T—rL * w( Ro(• f 1 a &' (T-C 2 jL e..J AtC. -23731
(Lot or Street #, Street or Road, City & County)
Agent's Name#: af.6"e7 LaCNe+^r•r
Agent's phone #: ZS 2 '7 s S" et 3 2
Mailing Address:
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. Z4NM`p"UK- a d aw0ina170Ti crjeF s ons m st'be prav'�'e�' Vkitt [i le es.
[/ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you mustnotifythe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also he contacted at (252) 808-
2808. No response is considered the same as no objection if vouhave been notified by Certified Mail.
VVAiVER 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' setba.ck requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
.zg�;,r 2L
Signature
cot Eu�o�dl3dt.
Print or Type Name
gyeo ewlr n+•.T DI- I
Mailing Address
KaaL+t.74 ►Vt 276/7
City/state/Zip
41Q 623 X2?1
Telephone Number
V--1- -zdfq
Date
(Adjacent Property Owner Information)
ignature
f�Cc C3 • C't�C�1'-mac
Print or Type Name
�dS N. r I S�
Mailing Address
it l Zi
Telephone Number
lb 7
lit �P� *���'
Date
Revised 2012

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
1,
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 13 a K 4t+ C &x !) k a V-e
Address of Property: 9' T •Z r <a.., Ro J Hal, ff<r / -.r (a /(I C• 23 r?
(Lot or Street #, Street or Road, City & County)
Agent's Name #: T4eu.st L aw t—to-c•+ Mailing Address:
Agent's phone #: st S'2 —7z S-• ° ( 7 Z
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;edesebfion�orclrwTn���I�s�amenslons must�be�proul�eef.�vitl�,t"tilsfe"�fer,.
•� I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you mustnotifythe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. 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, 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.)
C/2 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro erty Owner Information)
Signature
MIACE 3. t 'nS&?Nc^
Print or Type Name
Cis T 5T
Mailing
tCt ylstate2ip
Telephone Number
g/r 7/R
Date
(Adjacent Property Owner Information)
Ce•-Q
Signature
CAC. €c[&4%bK
Print or Type Name
gyaq ow(c. /Vq / IOPo
Mailing Address
hale.)). /U C -z`7® y
City/State/Zip �d
oft? 623
Telephone Number
Date
Revised 611812012

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: t�a,/ /"�ibca .vd 5'0 "J
Mailing Address: 9`/•e Co w!) *V-.pi ( i4 .
Ra4•: A. 4
Phone Number: 9/ 7 -- G z 3
Email Address: C06&c0ir+-%0&144%&W* q�uaJL�aa^
v
I certify that I have authorized 7-Aaon4.& La w a-eov c-P
Aaent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: W et,/(
at my property located at
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:
Signature
Ci}L t-o(w.e.�aLsoti
Print or Type Name
dv�Ne �
Title
Ir / -Z I .10 l
Date
co,
This certification is valid through tZ. / / / .20 % d 4
2)CXIA
2s's 3/

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: &Y--Cle qR6) U e
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Zas 6J EA-5T 5T-
qd' - Z!1• -7t341
Agent
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
rUM44Za
at my property located at Y2
in w e'County.
,A/L Zry3/
1 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
OwA)ef-
Title
-1Z I l(2 . �®
Date
tio%
This certification is valid through 0 20

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �CG/tx�/�ol� m.�% s
a (Name of Property Owner)
property located at / -3
(Address, Lo , Ell ck, Road etc.)
on �' in its 1�S 3
(Waterbody) (City/Town a d/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
U_iav_e objectiona to_this_proRosal_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in des ription b low
or,
Gorattac a site wing)
SLheA^cit•,q Q
fro
5
t^o�o�e d� � •
a5,
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Own1 formation)
Sigignnatturre
cat` Fd9*%&Jt -
Print or Type Name
RYoc o wts At�i T l0 4
Mailing Address
ZR4Celaa, ovc, ZZG(�
City/state2ip
Telephone Number
9'I q'-6 23 - %:a
Date 8- n-a-tf
(Adjacent Property Owner Information)
Signature
/,AtCi-tA-tZ L. MtLJ-5
Print or Type Name
Mailing Address
BIOS 1Ct�io?-a ��j®
CitN tCte/Zip2 -e� s a r-
Telephone Number
22C7 �®
Date
(Revised 611*12)

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We, the undersigned, having adjoining properties located on the Back Sound on Harkers Island,
NC have agreed to jointly share the cost of construction and maintenance of a pier to be
constructed by Island Marine. This pier is for personal use and is to be located on our shared
property line. The line divides the property owned by George C. Edmondson at 938 Island
Road, Harkers Island, NC and Bruce B. Cosgrove at 932 Island Road, Harkers Island, NC.
/0 t Date:
Bruce B.Cosgrove
932 Island Road, Harkers Island, NC
Sworn to and subscribed before me the I I' day of January, 2020.
Notary Public
George C. Edmondson
My Commission Expires
Date: I— 1 6- 3 0 ac O
938 Island Road, Harkers Island, NC
Sworn to and subscribed before me the Ito day of January, 2020.
Notary Public rJ,,r, , L3 . 5ii;Qj
�GGV HOLTp4e'
�01ARJ-
COUN�o',
l�la'DjDoa
RECEIVED
JAN, 2 4 2020
DCM-MHD CITY
My Commission Expires: Ju ai a�