54528D - Moore

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,:_.'LAMA / _DREDGE &FILL 54528
21T
NERAL PERMIT Previous permit#
w Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC_ p7 N 12 y O
❑ Rules attached.
Applicant Name A%CFiALt.
be 41mec R-cy Moog l
Address _; 11 U i� ^J r�E Gz w can C T
City KA r I ChN
State ZIP 21 G t 7
_
Phone # (1 '73o - 4053 Fax #
Authorized Agent RICK
"c s' r - AM W DocK_s
Affected CW $(EW
XPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF
❑ IH ❑ USA ❑ N/A
❑ PWS:
❑ FC:
ORW: yes / no PNA
yes / no Crit.Hab. yes / no
Project Location: County S rz(AA)S w% c K
Street Address/ State Road/ Lot #(s)
Ayr R.5,oc D;2,v>=_ (Lo-r# 59)
Subdivision
City SwNsr- �rA c H zip Z 84 L g
Phone # (104) S 6 3- 0 6 6 g River Basin L.0 m Orn ra,
Adj. Wtr. Body C A N AI- (nat man nkn)
Closest Maj. Wtr. Body 1 ^J l� c C-R r_ r�
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Signature Please read compliance statement on back of permit
,it 2 0 0 c 3'52.
Application Fee(s) Check #
PermitOffi s Signature
11-7 o 12 5-7 zol9
Issuing to Expi tion ate

To Whom it may concern:
Mike Moore is updating his Cama Permit
We are asking for you to respond as soon as you can so we can start construction.
Included in this package is a drawing showing a new docking station & boat lift.
Cama requires that we present this rough drawing to allow for review.
We look forward to your response
Any questions please contact me Rick West of AMW Docks.
Thankyou
Rick West 704-363-0668
Date 12-04-18

— • • : : ,..I •.
Name of Property Owner Requesting permit:
Mailing Address: ///.2D r C,.•�r(,Jooc� I —
Phone Number: !77736 —
Email Address:
I certify that I have authorized /`�'� LJ aSc�
Agent / Contracbx
to act on my behalf, for the purpose of applying for and obtaining.`all CAMA permits
necessary for the following proposed development: �11c� �FJ i•�.G - f,g-f, c�_/
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at my property located at / /1 t1 r S+
in. rgf,44~S G-xd'County.
1 furftrmoie certify that / am authorized to grant; and do in fact grant permission to
Division of Coastal Mark -KW rrf staff; the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating inforrnabon related to this
permit application.
Property Owner Mfonnation:
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Print or Name
10 i Jf4e r
Tift
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This certification is valid through }

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: %�IJ 1/E Wit C
Address of Property: UKr
(Lot or Street #, Street or Road, City & County)
Agent's Name #: /1 C �) \ G% / Mailing Address: / 707 BA
Agent's phone #: /ti� - jv�-�`b o-15 FIfe 7
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing with dimensions must be provided withthis letter.
�1 have no objections to this proposal. ____ 1 have objections to this proposal.
If 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. Contact information for DCM offices is
available at http://www.nccoa.4itaimanagementnetlweblcm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 i~ the appropriate blank below.)
71wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pr er Information)
ignature
Print or Type Name
i/lo7b ���.-LJzrx� ei'
Mailin Address
City/State/Zip
'?19-7.30- 0.53
Telephone Number / Email Address
/,2 -'4- 8
Date
(Ri rty Oyyn rmatlon)
Signatur
A,1 7J,4 on/ y CC) ✓t,v c'� out
Print or Type Name
� a y3 L ee s6v.cG A,CL
Mailing Address
I-ec-qlub &V Z'9ys I
City/State/Zip
710-20g,03j L 7_,91✓y'Cj1799
Telephone Number / Em it Address
Date
(Revised Aug. 2014)

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Nemeo/ Permit Holder
Vendor
Cheek Akmkw
Check Unomd _Permit Number/Comments
Cokrmn7 _ _ Column8 _
$ 200.00_ GP #72325D _ _PA_rct.
200.00 GP #54528D
Receipt or Relund/Reallocaled
Column9
_ 7334D
TM rct. 7313D
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CokmnJ
Columk
25128799503
1/2/2019
Joel Klass
Tom & Mesha Chadwick U SPS Money Order_ _
Michael & Kimbeily Moore BB&T
1/7/2019
Rick West
5352