71819D - Cable

DCAMA DREDGE & FILL No 71819 A B D
GENERAL PERMIT Previous permit #
Flew * ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attacheed. f ,r
Applicant Name _ry ( (n I J lL Project Location: CountyV\'
Address n may} Street Address/ State Road/ Lot #(s)
City \II.ZIP O`I�6t(
Phone # (7 01 �' W 5- E-Mail Subdivision
Authorized Agent City ZIP
Affected ❑ Cw A ❑ES ❑ PTS Phone # ( ) River Basin C
AEC(s): ❑ OEA ❑ HHF ❑ 1H ❑ UBA ❑ WA Adj. Wtr. Body NNW
nat m unkn
ORW: yes❑/ tno� PNA �/ no Closest Maj. Wtr. Body \\ Vy
Type of Project/ Activity ^yy } i� `� Y l V (r, A 1 ✓A f) A 6 (AC &4 x l ��l ✓�
Pier (dnrkI) In
Fixec
Float
Finge
Groh
Bulkl
Basin
Boat
Boatl
Beac
Othe
Shon
SAV:
Mor,
Phot,
(Scale:
Ing Platform(s)
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r pier(s)
ONE
i length
number
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i
avg distance offshore
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cubic yards
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ram
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Boatlift
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MEN
dine Length
not sure .
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yes
ws: yes;;.
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Waiv �
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A building permit may be required by:
( Note Local Planning jurisdiction) n '_c
Notes/ Special Conditions , MO �LN/-D �� &\U 041
r (''�r S 1-0U( 1)
Agent or Ap licant Printed flam�
Signature
I Please read compliance statement on back of permit
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
r 1 A tl PM j �� 0 ✓� I
PerrnitOfficer's Printed ame
�S*n ture
Iss ing Da Ex ration D to

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: o 41 Qb%
Email Address: 1 1
I certify that I have authorized �L _6S l,L,u ` �� del\ �mta�� M �4+ ()AC�
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 02 �� �' � - 7
in
County.
I 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:
Signature
Print or Type Name
Title
J2/2l- 1/
Date
'J
This certification is valid through l_I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
iNanhe of Proper y OWmer:
{:dress of Property: _ 0a Vk"A
i I tit cr Street K. Street or Road, C,tv
Agent's Name : rl s �-oy l� Mai Iing Address. _��� vwicLuu, a
Aqent'S p lone #. `— �—"� LJ) 1A n�(_
I hereby certify that ! ov:n property adjacent to the above referenced property. The individual
appiving for this permit has described to me as shown on the attached draing the development
they are proF:osing. A description or dravving. with dimensions must be provided with this letter.
I iliit l' 11,; flbicctlmis to this propi)sal. I ilm C oh�Cit'vils k) t;U.` tie'(I)t15:i1.
If you have objections to what is being proposed, you mustnotify the Division of Coastal Management (DCM; in
writing within 10 days of receipt of ties notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
i 1-finders ar.d tha` a pier, dock, mnoring pilings, breakwater, boathouse, lift. or groin most be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (if you
wisll to .waive the setback, you must initial the appropriate blank below.)
no %wish to waive the 5' setback requirement.
! do not :rah to waive the 15' setback requirement
(Property Owner Information) (Adjacent Property Owner Inf rmation)
rl %��)F. 1)1amn Printor ,Ya'
id
Ak
CIly'/C(BIRf�,f: � _ i::i::�/C!•-it';.'•�li•
T:�i6'rJil,>?!f= Itlrll;,i� r
'A01- 0
�F31Bi)I)[ttiF, j,l!!IRi;:ll

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Narie of Property Owner. - Z—J—�
Address of Property: _ C�Q k/, (ac� y� _-
1 of or Street #. Street or Read, City : Co orify
S�
Agent's Name Mailing Address.
Agent'sphona�: �IU_��=���— ��%�/,�C_gl�% --
I hereby cenify that I ow-n property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drav:inn the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I'tank' n-r obrctio l t Il;: to lht. t:r��l`tr�ai. ! i&t. t�h;ccitut.� t.� i.iis t;:'nit�is:ii,
li you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I undersiard tha' a pier, dock, mrioring 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 ,.naive the setback, you most initial the appropriate blank below.)
17o :vish to waive the 1 c•' setback requirement.
1 do not .rish to waive the 15' setback requirement
(Property Owner Information)
Prr;u nr 7�;{.ir• lei;rote
r
Teiepiu>!!r: Ptiunli:R1
(A cent Property Owner I ormation)
Print or
Aidwss
_C�110��-3_►- z

36a9�-

Date Ra Wved
Date DEposited
Check Fwn Name
Name of P@nWt No/der
Vendor
Check Number
amounChetkt
Pe It NumbenCommenta
ReeN t or RelundA%Wq cafed
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