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RTlFfED MAGI` RETURA REC lPT f�EQUE�iTED
ADJACENT RIPARIAN PROPERTY OWNOF ER MANAGEMENT
FORM
Name of Property Owrter
Address of Property
t1. SorOW or Road. Cty 3 Cokmtyj
Agent's Name # �i �'►
AgerN's phone #
Mad ft Address IN
l l� a , f Ri.-F 1,y ►,fi �lt�
hefaby cerllty that t am p'RO MIS a ft abov.
eAP"g for thm P&mk hM dMObd i0 me M Mown on b a�bol� rvmlProp" Tit& irtd{v n onI
ttteY ate prOPoextg, d n davabpm&nt
Y 1 RANDOM WAi
hm no objctAions to d6 pmpc ul i have ct>lec ions to this proposal.
r r aMNttltM b twiartr t+atrp pp y" salsa no* 000w*4 of Co+ahf
*�� iN a1 d of" note Con^gPo�Oo+ arM/r iaatbe m ivAr rF�rt�,
W � J ► �A ��{O.t�! per` _ can Biro beago bMill apt TN 7VAL No mpan" is
t undersUnd that a Per, dock, moo WAIVER SECTION
Dagt a madrtttan � Prt Vs, braeikwatef, boathOuse, Wt. of grakn must be set
Of 15' from my area of npanan acaom Unkm waived by me pf you
wtsh ID WtrUM fe sefta, youMift the aWopnete bionic below )
I do wish to WWW the 15' setback requvement_
1 do not wah to waive the 16, setback requvemant
(PmP rtY OW-W►pfomubon)
PO���o AbrrW °1 y3SL cep t
{Adjacent rty Owner Infotnpkbn)
A l
bA,,, Aj
-0
>rifsp�ione +,
ki&f Ly4r:
M.*k k14t,j,Nc
2.'? 7 /2
-710
Aattsad &IWeiY

Name of Property Owner Requesting Permit -M'CM
Mai ing Address. 3LtItffl
Cav'!j, N C- on
Phone Number:
Email Address: a. 1 n --S
I certify that I have authorized
Agera i Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
V-
at my property located at —ll Ly 38 IC4f4V L44%30 C"14-
in Gounty,
I U&NKMOM COnW that I am atithonzed to grant and do In fact grant permission 10
Division of Coastal Management staff. the Local PerrriN Officer and their agents to enter
On the afOr"OnImOd lands An connection with evaluating information rWqW to this
p&MWt application
Pnprty Owner Inforination:
51011 MANTS I
This certification is valid through

CERfiIFIED h18IL RETl1RN RECEiPi' K1=CZU E1S, Tip
DIVISION OF COAS•rAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER IVOTII~ICATION/WAIVER FORM
Name of Property Ovr!re,.
PH
Sh:<rt #, N're�;.
r )
. t �r t',ta::, l:ily R 3':ntatlyl
Agent's Name #k_W`C
ling Ada, r:c=, i t? j 1*�:) ,
'agent's pilo,%, # Glv
I heldby cprt,l tl �...f��..,,:��---_:.-=;..�::>�,�.,� ,______•_•=�-:
Y er own property ad,acen! kj tr;e abutte ref9fe►tCed Propert Th r
appiytrtg for this permi! has doscnbed to ►nz as shcwr on the altached dratiartr t 1e de. me rv,dual
they are Prcoosrng, f_dese'iption or_dravtinq. ±r;�th drmensic�ns Q_p
. g_ erclaprnei-*I
- - _ mils Gn r u�rir___ d � his totter.
r r . 1--.
• nc� e.�tcc,nun,, to Iltis �? rre•r, _ .
(61c:ca10115 to this prupos,rl
If you have inobjections0ato ►vlraf is being tilts oNiased 1�3�+ must na ry ilia Division of Coaatar�'ana a
writrrrg wlfhin 10 tle ,
s' fmf ron, NC, days of Jr.CeJpt of tilts
notice. Curres�nrtdc+nca s!rcruld L:
284DS-3R4.5. DC►4 representatives a �n at mnfred .0 1Zi Cardinal 9 merit (OC,.f) in
considered the sprne as no ob'ection if "o t►a co: Drive Ekl ,
roil have been rorified h C rfacted st ft)ft?) 796 7215. No response is
vr7iJlCd tAa,�,
I undersland that a pie: deck, rroa: tit WAIVER SECTION
back a minimum distance of 1S' fra,n r.•,y area Of rrl,an n acccs� u Mess Lvar�r?;1
'� pr,rngs, b ,enktiti�ate!. boattiouq;e, Lrt, or groin rrtrst be set
wish to ;aawe the setback YOU must inttjR! tr,o.
-rnnrnpr.ate t, am bFjj i by ire (If yotr
rJ ;�
I do wish to v:a7ve the ?ti'satback requirement.
- Y,, r do not wish to taa:ve lt.e �, .5 sett?ac+. 'Fur, ri:tT:;,n,
(Proprerty Owner nformation)
r''i11C l tP �
pr�rnt or Tyne 4V
MIL t. r L . C-�
g Address -- -
I 145yZ.
Te4ow- le AfumtrP, -- — • __
npc
Adjacent Nrcahetty� O-qner Information)
e7
4�';,.'J�!rl �ic;:ires::.. ��o r{c.•��w�..� 1'J2
��;epti7ni> + L4: J 7o j - -7(2.. - Q �) Y
,V 2S/ zzv

Daft Received
Date Denoalred
CMck From
Name or Pemrit Holder
Vendor
Ch—k Number
Chftk
amovM
Permit Number/Commentr
Rxel t or ReareMles/bested
Golumnl
Colo-2
Coemn7
Colo-4
C01-5
ColomnG
C hNIn7
C.1-8
Columns
_2/2612020
2/262020
-
2/26/2020
2/26I20201
2/262020
S. Wade Lee
Wade Lee _ 8B8T
Gtepory Taylor First Bank _
Michael Strickland BB&T
Michael B TracyBatts Imo _,�_ First Citiz n Bank
_. 4901
1016
- --
2474$
2364
200.00
GP 076243D
13mL 11468
2/2W020
_
Sea Dog Marine Construction. LLC
.f_
$ 400.00
GP 074897D
BB rd. 11189
2020H5ConstructionLLC
262
----
McPherson Marine Services LLC
400.00GP#748920
BBroL11467
2262020
00.00
GP #7 30
T rCL 1