67277D - Patterson

�CAMA / ❑ DREDGE & FILL �1
31EN ERAL PERMIT `� ` J` Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources tt, `
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �� n ' l (?e
jjt Name I 6,V�V96W r
Project Location: County �j�'L1i�at'^� C (kM k
—7 i+ -7 49 �6� t�� �� V-1� r . Street Address/ State Road/ Lot #(s) �
/ State ZIP 'n D iL2 P'I `6
( l �) ' ��g E-Mail Subdivision
edAgent ml �l}i 1� S fC�ity�/C )IPUY1 ��� ZIP L
ElCW ElEW ❑ PTA AEs APTs F�h(on-e Jf (AID 441203 -River Basin uWM b
❑ EA ❑ HHF ❑ IH ElElUBA N/A Adj. Wtr. Body .'�� Sp � d Cret � - /r
❑
yes P PNA � /�no� Closest Maj. Wtr. Body t•'L'V�J
Project/ Activity
-k) length_
itform(s)
Platform(s)
ngth
nber
i%Riprap length y0 r
distance offshore
x distance offshore__
cannel
sic yards
U
,A�IF
Ming
(Scale: V
vV'
_ocal Planning jurisdiction)
❑ See note on back regarding River Basin rL
" ! — r1 '1 r- . 1 k1 I -

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: g/q -
Email Address:
I certify that I have authorized-c iv��1��
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all C'A`MA permits
necessary for the following proposed development:
at my property located at '
in PNt-L, - 6 County.
1 furthermore certify that 1 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
rint or Type Name
DGvh &-,--
Title

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Stnbet #, Street or Road, City & County)
Agent's Name* MailingAddress: L/ 7
Agent's phone #: c1 t 0 � 1-1 �- � 3� I lFJ k � , , Li iD
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are p posing. A description or drawing, with dimensions, must be provided with this letter.
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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if Lou have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' fro.m 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.
(PropertyOwner Information)
Agnature
-
ISM M-/pb Name
(Adjace Property Owner Information)
uo. Av�
Signature
d c6egA gck-t-"; t;
Print or Type Name
.O 1 1

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: D/' /CV-_�)u-oa 4 id -�5eQCL -
(Lot Street #, Street or Road, City & County) /�
Agent's Name #: � �l Y� \�S Mailing Address: ywl Py bce
Agent's phone #: Lt � i�' LI d qL1 %y
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are pro sing. A description or drawing with dimensions, must be provided with this letter.
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. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
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) (Ad' en Pro erty Owner Information)
S- 4aure Signature
Print dr Typd Name Print or Type Name T