Eastman, Anne

®�CAMA / ❑ DREDGE & FILL N9 78442 A B D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue [Partial Reissue Date pre us permit issued
As authorized by the State of North Carolina, Department of Environmental Quality r n
and the Coastal Resources Commission in an area, of environmental tern pursuant to I SA NCAC
Ryles attach d.
Applicant Name I t j Project Location: County
Address { (w ' a Street Address/ State Road/. Lot #(s)
City t �i'U l l tat i t ZIP 7
i,
Phone # ( �� 1. / E-Mail
I
Subdn ision
Authorized Agent J
/
f (l �'
City a
- .
Affected AtcW bEW
�/�PTA `
El ES ❑PTS
Phone#
❑OEA ❑HHF
AEC(s):
DIH
El USA ❑N/A
Adj. Wtr. Body
❑ PWS:
ORW: yes / no PNA
yes / noClosest
Maj. Wtr. Body
/I
Type of Project/ Activity
Pier (dock) length ( /') X i
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)'^---+
Groin length
number
Bulkhead/ Riprap length
avg distance offshore "
max distance offshore
Basin, channel
cubic yards---"
Boat ramp--
.
Boathouse/ 6
atlift "
Beach Bulldozing��
Other
J✓r
I
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes ho i
_I
Photos: yes no/ JELL
Waiver Attached: iA� no //
A building permit may be required by: 7.�
( Note Local Planning jurisdiction) /
Notes/ Special Conditions 1 , `. t
Agent or Applicant Printed Name
Signature " Please read compliance statement onback ofpermit
T `T
Application Fee(s) Check #
ZIP , ., A
I( I
(Scale- I — ) )
u See note on back regarding River Basin rules.
i
PermitOffcer's Printed Name 1
Signature
j /a 4I�q o A oay
Issuing Date Expiration Date

A6ENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: A"iNe' �S
Mailing Address: 1 Z
Phone Number: _� �✓
Email Address: rvtoa`
I certify that I have authorized
� 1--joL
r Agent / Contractor
W
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: P �✓ ��
4)'�a( 80R4- II -4-trtS kar1(!
at my property located at �$ t) 'L
in C/}Z7Z er- 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.
Property Owner Information:
Print or Type Name
im
JAN 14 2020
O04f jwllO O/�

,nib Cam"
I hereby certify that I own property adjacent to -
s
e fyProperty Owner)
property locate at 6 7 pm !'
(/S� (Address, Lot, Blp , Roa¢b etp.) A / c . N.C.
on LS1 G in at, r"
(W t rbody) (city/Town and/or County)
,,Was as described to me. as shown below, the development proposed at the above
do
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)
RECEI\IED
JAN 14 ZON
or
,M-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
e. (If you wish to waive the setback, you must initial the appropriate blank belo� 1.)
j ".16 wish to waive the 15' setbretback
equirement. )
r� I
f' I do not wish to waive the 15' requirement.
.t PoV
Owner Information)
roperty Owner Information)PILJacn rtr`

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
a I� me o Prope Owner)
property located at (p �l
(Address, Lot, ck, Rgad a c.)
N� • ,
on 7P4 � O�, in QA.�-4. � N G N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
` location
JAN 14 Z020
ocu� *H®car,.
—
,.l

Name of Property Owner Requesting Permit: N LSA'A
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
1 Zi t
Agent!
V�
to act on my behalf, for the purpose of applying for and obtaining all LAMA, permits
necessary for the following proposed development: �-
4�a L 011 I 1 [its 1-2!T1(41
at my property located at
in 22��--95-r' county.
"- -Ij e-, 7e5 1te
l furthermore certify that l 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:
Print or Type Name
O w �jck
Title
Date
This certification is valid through 1 _1 ',

I hereby certify that I own property adjacent to "' g^ `,
/ ` r S(yame of?roperty Owner)
property locate at
(Address, Lot, Blp, Roayrb etp.) A 1 C N.C.
on n to . `-} /"
tw rhnriV1 (city/Town and/or County)
he applican as described to me, as shown below, the development proposed at the above
do
have no objection to this proposal.
*�f 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)
Y
\i
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boatho e, lift, or groin
ust be set back a minimum distance of 15` From my area of riparian access un ss waived by
e. (If yourl4mo
to waive the setback, you must initial the appropriate blank belo .}
"`�-°�" wish to waive th=ckrequirement'.
donotwishtowaivment.
roperty Owner Information)
Dare
-Valid for one calendar year after signature'
(Revised Aug, 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to ✓
l) ) a� me o Prope y owner)
property located at __b�
���( (Address, Lot, �gck, Read, e1c.} G N C,
(Waterbody) (CityiTown and/or County)
The applicant has described to me, as shown belowthe development proposed at the above
location.
� 8 Yl 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
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 bank below_)
f do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (A-djacent Property Owner Information)
✓ _.._a `�dt�l�a-,';� Y"tn11(", 4�'}5.�*`;�?::,�It�+:�rr:
address
'Valid for one calendar year after signature'
Print or Type Nan;e ,
V11 Ong Address
Ci:ylState/Zil>
el >ho re Number t email address
i r? Lc
?.R&vised4ag 2014)

11 j. uY ��� (((
,�,..�
� }.{y .m .....
¢'-
�
S .. ' -.