72742D - Paul

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Roger Paul s
property located at 117 SE 15th Street (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on Montgomery Slough in Oak Island N C
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
vJ
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.)
I do wish to waive the 15' setback requirement.
IF IJ I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Roger Paul
Print or Type Name
105 SW 1st Street
M fling Address
6ak Island, NC 28465
City/StatelZip
Telephone Number/ email address
Date
'Valid for one calendar year after signature`
(Adjace t Property Owner Information)
Signature
Oak Island Town Office/Steve Edwards
Print or Type Name
4601 E. Oak Island Dr.
Mailing Address
Oak Island, 28465
City/State/Zip
9'!y
Telephone Number/email address
l _ / d -- e I
Date *
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to Roger Paul s
(Name of Property Owner)
property located at / ' SE 15th Street
(Address, Lot, Btock, Road, etc.)
on Montgomery Slough in Oak Island 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 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)
ftis7'e.11 &)0r- -&t-d fer 04,v\c- ttr r-o�L f ulspof
V/Afip-r �-Ae 0r r.- -e %a
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Roger Paul
Print or Type Name
105 SW 1st Street
Mailing Address
Oak Island, NC 28465
D4tylState2ip
Telephone Number/email address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
a ature
OAariah & Mich el Brazil
Print or Type Name
113 SE 15th Street
Mailing Address
Oak Island, 28465-6514
Telephone A Number/ email address
,"'J
Date *
(Revised Aug. 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
10 S S VIj
co) te-e
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ME
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/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: D-e t%C - 1' ea 12-1 &
Of
at my property located at --Ij
in r ,v5 u/C--)C£ounty.
I furthermore certify that I 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.
Pro erty Owner Information:
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ature
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Print or Type Name
6)k) ,Jc�
Trtle
Date
This certification is valid through x I / C�

Date Rec~
Date
Deposited Check From Name Name of Permit Holder
Vendor
Check Numbs
Check anmmt
Pennif Numb lCommente
Recei l or Refund/Reailocated
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1/27/2019' Joel Klass Ro er Paul USPS MoneyOrder 2512879641Q $ 200.00 GP #72742D TM rct. 7442D