Mercer, John (2)

C7�AMA / aOREDGE & FILL
i
GNERAL PERMIT
ew ❑Modification ❑Complete Reissue ❑Partial Reissue
WNU1610
Previous permit #
Date previous permit
A B C) D
As authorized by the State of North Carolina, Department of Environmental Quality /� .)) rl it
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / 7/ 106
/�� ,, Li Rules attached.
;Applicant Name � D Q A J t 'E4v e.//e Project Location: County (-;
Address �� Fb+tBAIcI) Q_4 Street Address/ State�Ro^ad/ Lot #(s)
City e4,fU..A^L,9 13 q State NCZIP— —k5frLi /(0 t`,4Iii9l A .124
Phone # ( Z E=Mail �ZZ2r_91 �}dJr rm Subdivision
Authorized Agent 7 06 7�1i 14l f (jY City j9fGi,(�'(i %i lE ZIP
❑Cw 62W [I PTA BFf ❑PTS Phone# (7/�) � River Basin /{J/"
Affected 00EA ❑ HHF
AEC(s):
❑ IH ❑ UBA ❑ WA
Adj. Wtr. Body >9C(nO
!�
.VUU1 Oman /unkn)
❑ PWS:
�
U4Z_-n
ORW: / PNA
/ )
Closest Maj.. Wtr. Body �f!
2 _
es no
yes
Type of Project/ Activityrf)
✓�r�
Zr U�
(Scale: ^/ )
Pier (
Fixed
Float
Finge
Groir
EBulkl
Basin
Boat
Boad
Beacl
Othe
SAV:
Mora
Phoo
9.-0
Waiv
A building permit maybe required by: (t7(U/1 0-1 r1Gifd1 /1� /� CP..- ❑See note on back regarding River Basin rules.
( Note Local Planning jurisdiction // I� /p / j
Notes/ Special Conditions �^!? � 7 i1 4 ,�i/ i (f iL� %~ yNlifOf 7 4Y l41'rt✓7fE'1 "?6141 fil / 114 �f/1 C9t
_40 _ R O O"1 �'� 1 S
oadrt(s rnl( c�G (��0 1'1A(�LrrH
,agent or Applicant Prjnta.e -
� !�j/t� ,//tom.-�.J ✓
ignatu "Please read compliance statementon ba , p rmit'`*
d oa 3b
Application Fee(s) heck

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1,ky&&-�
Mailing Address:
�r✓t eve - �vG. Z"'o6ge)
Phone Number: Z d yZ
Email Address: ,o/hn M erGev /222PRn�u �� COS
I certify that I have authorized y/.2j2/ ""ewe, C>/i A6
2, 7z3-,.3 Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
/A.)5na-41�
at my property located at(i
in 49hZIUYz8T• County.
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.
Property Owner Information:
Signature
�/p u�r I�evLP�
Print or Type Name
Title
Date
This certification is valid through /21 1 Zo %U ' RECEIVED
MAR 13 2020
DCM-MHD CITY

MAR 13
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
DCM-MHD
I hereby certify that I own property adjacent to/ /('��(/GP� ,s
(Name of Property Owner)
property located at 2�0 1erAt_t 4 Vf04V�
/�
(Address, Lot, Block, Road, etc.) qq
on 90we %C/U/t%Q —,In CW ef'lYGA �W N.C.
(Waterbody) (Cityrrown arfdlorCounty)
The applicant has described to me, as shown below, the development proposed at the above
. 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)
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.
xI do not wish to waive the 15' setback requirement.
(Prop ty OwnerInformation)
Si arxre�h41_,)
i�lP�C.P.V
Print or Tye Name
2/��x1A TI2�v13'
Mailin Address
address
`Valid for one calendar year after signature*
Information)
LLl-
fvv
Telephone Number/email address
1Y)o►'nMa,�on�@ yahoa,cotit
Date*
/ (Revised Aug.2014)

may,
a
A)e- Ne w
0
¢
61bi)eD
Z
, W
F
t
/W
0
2
(N y( o
(/�C7YU U
�L✓0�/G ¢
RECEIVED
MAR 13 2020
DCM-MHD CITY

212 AIN wdA-
P.O. Box 4923
lsmerold Isle, NC 28594
[phone]
col,
2J5
lroyo-g-
s
✓,vti� �jUG�,GfGy�S
Y�
/7
,RECEIVED
MAR 13 2020
DCM-MHD CITY