67249D - Rowe

I AMA / Q DREDGE & FILL A B
3"ENERAL PERMIT Previouspermit#
New ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 6�7 �� - b b0, 1 1
❑ Rules attached.
t Name (� (� j �� � Project Location: County �(^Vy%SL'Ni Zr
'4- . n,I �� Street Address/ State Road/ Lot #(s)
� 2 y1J State�&'C ZIP i� i _ 0 VV -1"'.
( f 00& E-Mai l __ __ _ Subdivision S C V1 d �`x, i
ed Agent -� Cx nl City ()(f a o- S �. ��� ('� ZIP � L g�
❑ CW ❑ EW ❑ PTA XES �QftS Phone # River Basin L- t
C OEA ❑ HHF ❑ IH ❑ USA ❑ N/A S6 "AJ
Adj. Wtr. Body �! f'—
C PWS:
Al
yes / m6' PNA yes / Closest Maj. Wtr. Body �'��✓
' Project/ Activity
ck)length
atform(s)
,d/ Riprap length `1(1
distance offshore
x distance offshore _
e Length
not sure yes
ium: n/a yes
kttached: Lyesr 9
ng permit may be required by:
Local Planning jurisdiction)
(Scale:
❑ See note on back regarding River Basin r

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �c cf `f� Avl) cc/�
Mailing Address: S �J� ��-c�. `�cpe-C4 A l•' _
11- (.1-se)L, ALL . ED-
Phone Number:`
Email Address:
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: L-."
at my property located at
in (�rc,,n5 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:
X446vOW. 4wx-,
/ Signature
Print or Type Name

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORMA
Name of Property Owner: k ak _
Address of Property: t001 t7
(Lot or Street #, Street or R ad, City & County)
Agent's Name* v 1% _
Agent's phone #: (� ) ()' sir ti,- aPC' a'a
Mailing Address: _Yc'E % (. LX4 �'i • `t
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this p it has described to me as shown on the attached drawing the development
71peffici.
they are 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.
(Pr erty Ownetr,Infformat' n)
W I
Signature
Print or Type Name
(A,djacent Property Owner Information)
Si fnattcre l
Print or Type Name
2O's 'S/ x k... -5�2 t~� A/L.0
Mailina Adrlrnss
Mailina Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
R
CL
(Lot or Street #, Street or Road, City& County)
Agent's Name* J-u r --) ( S
Agent's phone #: 0116- LfLf _3 - 2253
Mailing Address:
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 pr osing. 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.
(Prope Owner Information)
Signature
Print or Type Name
(Adjacent Property Owner Information)
Signature n
Print or Type Name
Mailing Address
1P,b.V'11� YIz4
Mailing Address