71830D - Kramer

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:,
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Mailing Address:
N"
Phone Number:
Email Address:
I certify that I have authorized T-iiAU ANA 0 YL,
Agent / Contifictor
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
in -LWIIS 101, C -'Vv County.
I furthermore certify that / am authorized to grant, and do in fact grant permission to
ri
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating Vormation related to this
permit application.
Property Owner Information:
signature
F-
Print or Type Name
Tiffe
Date
This certification is valid through -2,4_E

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
acil N N E - �(- �? 10% Ml.= (Z I
(Name of Property Owner)
property located at siZ6 �� . ,�e7AC �4 'Z)Z
(Address, Lot, Block, Road, etc.)
on C-AJV At_ in U/'� K S LA1U p , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to this proposal.
�N p` `'
e- i2U� 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)
s E C C) V A- ,T.N Cf-
b� f P-aO,N
WAIVER SECTION
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.)
Wdo wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement. t�—s J:5U�- AAkc�n
(Property Owner Information)
��'
Signature
Print or Type Name
Mailing Address
City/ tate/Zip
Telephone Number/email address
2 ^ 75-
Date
(Adja301nt,P.rop_9rty
Si«natt.e*
Print or Type Name
Ma�nc,�jj��Adress S
,c
City/State/Zip
Telephone Number /m eail addressl
07 / 0 7 ? -9 6 V4-�-
Date* 2,1 Z v )i K
'Valid for one calendar year after signature'
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 751n t' 1 KL('a)L' s
(Name of Property Owner)
property located at Ls�" '&.h or .
(Address, Lot, Block, Road, etc.)
on C-(-L✓ aj , in O 1 ,--4C1AJ' N.C.
(Waterbody) (City/Town and/or County)
The a pkant has described to me, as shown below, the development proposed at the above
f � I
I P��a'_- I 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)
s' �NO
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, h stater, 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 appro-riate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Si n ture`` �� l
Print r type Name
ling Addss�
Cit /Stat 2i JV�
43
Telephone Number / email address
Date
Property C}vUnbr Infofmatjion)
V►
(+� �S � 1WYvtii
or Type lyame
A1Idres1-- l t t C 77 3 Z
Telephong h1u ber/email address
�
Dare
*Valid for one calendar year after signature`
(Revised Aug. 2014)

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Date Received
Dere De s/red Check From Name
Name oI Pormft Holder
Vendor
Check Number
Check
unr
Porrn/r NumbenCommenrs
Recei r or Refund/Reallocated
Cofumml
Column2 Column3
:1,
C.1-4
Column5
Columns
Column7
Columns
Column9
6119=19
Back.ater Marine C ns
1229
$ 200 00
GP a718 0
846