71831D -Finn

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:y V j �' T 1VAVA
Mailing Address: 4o 11 1P5 2-6.
Phone Number:
Email Address: GY'd 0 c 4010 C.,o I. coeA
I certify that I have authorized I�`�a- MCPI'1e''R�11 I M Sevvi zs
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 131&1 k-►'lea-8
�rtSfiA-1 la -'I I Iry �-ice I I Y 1-1 Sw j Dec L--
at my property located at _30& RIvey ✓-r- /\%L
in FWW,5v,) 1 uG 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 Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
ASigniature
Print or Type Name
Title
Date
This certification is valid through

CERTIFIED MAIL •RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
W 1111Gw�
Name of Property Uwner: _ _ t Av% —
Address of PfopenY L'._' 3 ?:,-AU
-A 'De v`'�'k�' 04%* 9rU"Lv-) t'cic
F &+ 24 36-1
(tot or Streel #, Street or Road City b C&m►
AnRnt'S Nante It
Mailirg Arktress* I I ru_� ° w E t-
Q1VQ .
q l�: 4Q Jilt-,
I itetebv certifv that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on tie at,acherl drawing the development
thee' am nroposing ° ��""tDtion or dr na with dimens+4its ''rust t)e provid@d with this Letter
I hsrve rtu <�htections to this jwojx.0 i huvc oijections to this projaisal.
r.
%►rou bare otyechons to what is being prupossd, you must rwUty the Divisi0Pt or Coashf Management (DCM) in
,vr1fjnq within 10 days of receipt of this notice. Cor%esporndance should to maitod to 127 Cardinal Oliva Ext,
Wilmington. NC. 28405.3845 OCM representatives can also be contacted at [phone] No response is
considered the same as no objection if you have been notfffad by Certi/red Mail.
WAIVER SECTION
I understand 1w. a pier, COCK. mooting pilNl9s, breakwater, boathouse, lift, or groin must be set
back a minimum distance o1 is' from my area of ttpadan access unless waived by me. (If you
wish to waive the setback, you must initisl the appropriate o!ank below)
-77!�? V-- _ I do wsh to waive the ' 7' setback requireirent
i do not wish Err valve the 15' Setback fC�UlrenlC!11
(Property Ow er Irprmation)
Six►utf►rre
\Ni1 k �C�w�nV-\
Pr►nt or Type Nam"
L".)1 _prAI I II ins Q� -
Mailing Aaftss
v (- acts
C;ryisrare ►A
�GV -qjS- 4qj
Telephone N7m7
r
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f)nr« -
(Adjacent Owner Intottnatlon)
Six Owe (�`---
arint or Type Name
(Wafting Arkiress `- —
S�VV �C Z�9 L !
Ctty/State0p
1(� 2-'-1 Li -_
Tefephon .. umbw
--
Revised 6/1&2012

CERTIFIED MAIL ;-CTURN RECEIPT RFQUESTEO
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIA�N/�P�ROPERTY OWNER NOTIFICATION)1NAIVER FORM
Name Ar f'rOpP.lt}' ()V11'tlf . r" t I 1 i, cw " t 1 ^4 1
Address of f'�i;�crty l- . u-.'—A pce VQA - 1 tie h-fi �� t 24' 3to-1
;:.at or �trapt #, Street c� itnarl .:ity � �:.ounl� r'Ll4"15u] � L IC_
Mailing Aridress• 10 � N ✓H W'fd t c
Aurnl'sphone # g1�:Li►���"
I rrp(ebv certifv that owr proporty adjac pnt to the abovp referenced property. The individual
applying for this permit has descr,bed to me as shown art the attached drawing the development
Ihov arP -rrovosing A.descriotion or drem- na. with dimenstgnj. must be.prov►ded with this letter
I hnvc lio oojectlom In t'1t'; �r:rl4lo-.0 - i h.n; ulto this plopimal.
Ifyou have olweetions to whwris behip pouposed, you must notify the DJWsion of Constai Management (OCM) in
writing within 10 days of recelpt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
WiimAngton, NC, 26405.3845. DCM representatives can also be contacted at [phone] No response is
considered the same as no oWdon it you have been not(W by Certified Mail.
WAIVER SECTION
I understand tha', a pier, coc<. mooring pilings, breakwater, boathouse, lift, or groin must be set
hack a minimum distance nt 1 h' from my area of -nadan access unless waived by me. (If you
wish to waive the sethark you Must initial the Hpp,opriate tmink below)
I do w ah tc waive the ' 5setback requiren•ent
do not wish to waive the 15' setback requires eni
(Property Owner I*rmation)
Vi•trrrutrn-r
WCal.X, 41y,, -
Print (;I1'ypro N:rr lu
t4rrndoi(J IlticitYl4'
C�ty/;3tate2�p
'Aisphnne h''rrr?bF'
"Jim.
a•
(Adjacen Property Owner Informatlonj
c-'ant or Tyjl s damp
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C•tyrSislerlrh 1
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releWrorIo numb,:
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ReViSOd 61f &2012

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Date Received
Date Deposited Check From (Name)
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit Numb- Comments
Receipt or Relund/Reallocated
Columnl
Column2
Column3
Column!
Columns
Column8
Co.,
Column8
Colum.
/1 7
McPherson Marine Services LLC
William F-dThomas Rabon
First CNzens Bank
400 00
GP #718J1
Tmac rct. 8469