72341D - West

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: o „ NA . �j)
'\ J
Mailing Address. -�YOq �A� t' 00&�'
Phone Number:
Email Address: _W S� u)� '�,0.�` t✓� S - Q-Z M
certify that I have authorized�n,�4,�0��
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA pe J' s—r
necessary for the following proposed development:
at my property located at C—
in �covE�Z 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
o
Print or Type Name
Title
013 I—Ll/ 6?
Date
This certification is valid through
RECEIVED
MAR 11 2019
DCM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _�Q,c��,f.S �v,SS�t✓���'c� -s
(Name of Property Owner)
property located at 'DID .1 �� s,,.�1 \����� �
o'MS e ,\� t � g 1Address, dot, Block, Road, etc.
on _, in \c �\ , N.C.
(Waterbody) (OW/Town and/or Counitvl
The applic a described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal,
l 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, 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) (Adjacent Property Owner Information)
li
S' ture Si re
Print or'lype Nq�= PPt or fe Name
Mai ng ress r l , a 7i did SS
`GV I
City ate/Z1p City a e&
1Z�-�Teko Iona umbe Tstephone Numbe
C I V E D
�l 57
Date Date MAR 1 2019
30L/t rt klu� i h t'`l \e4-h
V1 4: f b i Ot"WHMVON, NC

Property of:
Mr. James Musslewhite
20 Island Dr.
Approximate
Property Llne
Property of:
Mr. Tommy West
26 Island Dr.
Exlsdnp
y)
Note:
Proposed Bulkhead will be irstelled 2
In front of the existing buNQread (water
T
side).
ro
Approximate
Property Lk e
23'
Proposed BL*hmd
Property of:
Town of Wrightsville Beach
28 Island Dr.
DRAWING NOT TO SCALE
RECEIVED
MAR i 1 2019
DCM WILMINGTON, NC

A
_.07,
IMM
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i
n

Date Received
Dare Deposited Check From Neme
Name of Permit Holder
Vendor
Check Number
Check
amount
Permit NumbeNComments
Receipt or Refund/Reailocated
Columnl
CG/YRmi Column3
Column4
Column5
COlumn
Column7
Column
COlYntn
3/18/2019 1 Intercoastal Marine LLC/Crav Hutton Tommy West BBBT 5030 400.00
1 GP 72341D
i I rd. 7340D