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Check Number
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Allied Marine Contractors LLC
Curtis Corder
First Citizens Bank
7815
$ 200.00
GP #74763D
GP #74380D _ _ _
Tmac rct. 9081
H5 Construction LLC
Jeanette Spear
BB&T
2407
$ 600.00
BB rct. 7942
Warren Fischer
Warren Fischer
USAA Federal Savings Bank
1039
$400.00
GP #74780D _
TP rd. 9495
Allied Marine Contractors LLC
Richard Rose
First Citizens Bank
7728
$ 200.00
GP #71842D _
Tmac rct. 9076
Allied Marine Contractors LLC
Dan Taylor
First Citizens Bank
7809
$ 200.00
GP #71844D
Tmac rct. 9077
Allied Marine ContraUors LLC
Robert Evans
I First Citizens Bank
7$14
$ 200.00
GP #71806D
Tmac rct. 9080
F and S Marine ContractorsInc.
Am DeVe a
PNC Bank
8170
200.00
GP #74548D
TMc rct. 8296

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
0
Address of Property: i �r Roadr CA
(Lot or Street #, Street o, City &County) /1
Agent's Name #: �/Ilr�f�r� Mailing Address: _ 1,� yo,- o'I U _
Agent's phone #: _� — � -a 5 Z c� 140" 11 G r?
hereby certify a own property a lacent to e a ove 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 with this letter.
GJAZ
_L,-/'- I have no objections to this proposal. I 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 h(tp:1Avww.nccoastalmanapement net/web/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mai!
,
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.
you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
K(R- I do not wish to waive the 15' setback requirement.
(Property caner I formation)
Sign ure /
Print or Type N
62l.�i/11A,(a
Mailing Address
City/State/Zip ( 5
y62 S- ya o- p q7�
Telephone Number/Email Address
Date
(if
(Riparian Property Owner Information)
Signature
r.
Pint or Type Ame
6 n n..W1f11M 6 c&.�
ailing Address
City/State/Zip
qt 4- 0'2.4/— -?-2 a
Telephone Number/Email Address
6 L 9
Date
(Revised Aug. 2014)
#'
`mow;1liqlly
NOV - -

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: aft pr
Mailing Address: 11 1)1) 4 �d a A6 e
Phone Number:
Email Address:
I certify that I have authorized
AL
-rl
Agent / Contractor
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 CpD tI %i%%. ueC4
in u1. k,( County.
l furthermore certify that l 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:
Sign ture
Print or Type Name
Title
/ Date
x owty woo;
This certification is valid through
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