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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ,e-1qPre_\j � . EZZG11e
Mailing Address:
Phone Number:
5GO S E46-f- Va.ch+ DV ve.
UL i slate , NC- U 46.5
G 10 1449 00-7.5
Email Address: hb$G 0 7 G) ma-i / . C Cwti.
TcsSc_
I certify that I have authorized Se"'<GS . 1'rFVW a-) ,
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 k3oog Ggs + umt aY1,44_
in BY1415 6c- County.
1 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 9r vner Information:
Print or Type Name
The

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to-t�CYl.H 1522eI IC., s
(N a of Property Owner)
" property located at �J�g E. "4&K i;V iJe , L. % 4 g _ )yGj
1�I (Address, Lot, Block, Road, etc.
on , in (�y 1= , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I 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)
�eplace. a I0x lu exi5-F�n9-�aa--I-t�� d«�c
VN i�h A. heW � 0 u l D-CJ0a--1"Inq
J
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
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.
(P perty Owned Informa . n)
s /
Print o Type Name
(A -acent Property Ownnformation)
Signature
Pn'qt.gr Type ame
i Q19 L

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent toE22ei IL I
(Navhe of Property Owner)
property located at 5cog E, \16tK+ Vvwe- 1_ _ i _ R l „A
l�fir4Lc I (Address, Lot, Block, Road, etc.))
on , in (�t le ! SIGH
N.C.
(Waterbody) (City/Town and/or County)
The app i ant has described to me, as shown below, the development proposed at the above location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
�plaCe. a IDx to exis+i'nqc�-I� -�inq dxlc
J J
W i-hN A. hAv
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.
(P perty Owner Informa •on) (Adjacent Property Owner Information)
Signature
Gl, ll S�� C�ruar�s
Print &Type Name n
Mailing Address.
Print or Type Name
= Yeti
AAnibnn Ari,4 ..

U,-
5 Hwy Minor Parcel
Hwy Parcels
W
1:1,006
0 0.0075 0.015 0.03 mi
0 0.0125 0.025 0.05 km
Brunswick coLrdy cis