Atkinson, Leon

R IGAMA / ❑ DREDGE & FILL W 78493 A B &C D
�k NERAL PERMIT Previous permit#
m ❑Modification []Complete Reissue El Partial Reissue Date previous permit issued
As autlioriied by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources CommissI 'n aj� area of environmental concern pursuant to 15A NCAC
❑Rules attached.
Applicant Name L, Project Location: County 4- E`r �<
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Address J ." (AC. , ;
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Phone # ( 366) " E-Ma
Stater' ZIP,2 -707-t
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Authorized Agent
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pES- ❑PTS
AEC(s): OEA ❑ HHF ❑ IH
❑ UBA ❑ NIA
❑ PWS
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no
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
s•
Application Fee(s) Check#
Issuing
Name
- L)
on Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �-'eoo 'i K/w'SUd
Mailing Address: 9T7 Pts.r?.j'x»
Phone Number: 33 & — VGS = I4U0 G
Email Address: Z2 oZ7a05'�✓avxa,�Cvrvt
I certify that I have authorized t✓ / ///Cv/Aee� ��5
Agent r Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: U:icwer , or'C R4L rah p
at my property located at 120 -5-4w L� / ,A, e' lZj¢-f,ke,,?x-J -
in - - >)2e 7� 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 Ofllcer and their agents to enter
on the aforementioned lands in connection with evaluating informatlon related to this
permit application.
Title
4, ! Z5 1
Date
This certification Is valid through _4 1.
RECEIVED
JAN 3I 2020
DCM-MHD CITY

DJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent to Lre 0 N Prtk IN SO in 's
(►JaPasme
property located at 12,L� Sflm Carr L-tof Property Owner)
(Address, Lot Block, Road, �rtc.) (1
on 0�-� OU.r�r , in -?•iApUi=qc i TCL!' t . N.C.
(Waterbody) (CltyrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must till in description below or attach a site drawing)
get" ATTAcHc'p S)< rrt/tS,I
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.
I do not wish to waive the 15' setback requirement.
(Property Owner fo ation)
PE4 7-
Pdnt Type�(ame
Malling
City/Sta'a"Z'i�-pr
a�75
Telephone Number/email address
9 1e/P awS %iflnk�,'f/l artiePsPa c2
alid f r one calendar year after signature'
(Adjacent Property Owner Information)
0.
Print or
Telephone Number/email address
Dale -
�-Lfq
(Revised Aug. 2014)
RECEIVED
JAN 31 208
DCM-MHD CITY

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RECEIVED
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JAN3!\d
.
DCM MHD CITY |
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L L-y'-) A7-k llvS'on s
(Name of Property Owner)
property located at 12-o 34)t '�s'f Lan
(Address, Lot, Block, Road,
on ac-y in I- .y z*1C2S N.C.
(Waterbody) (City/town and/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.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must tlll In description below or attach a site drawing)
'Sec /-) T'jpc:NC'r> ' e %L% /
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.)
(Property
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
A) -
Signature"
LdOkC� T YrvuPaz LLG
Print or Type Nam
2LLA Lin'me Ruoh I;oaa
Mefpng Address
Telephone Number/em it addrb'ss
Date*
(Revised Aug. 2014)
'Valid for one calendar year after signature'
A. RECEIVED
JAN 31 lUd
DCM-MHD CITY

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�/ CEDTIFlLAIE DF C%DMPTIf
I WE) HEREBY CERTIFY TF
O THE PROPERTY own
To W..IU9) BYDEED BOOK
OtGUJ TI N qR fJ BrER
RPGUUTIONS DF CNf1ER
RECEIVED
JAN 31 2020
DCM-MHD CITY

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RECEIVED
JAN 31 2020
DCM.MHD CITY
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