69307D - Harrell

CAMA / DREDGE & FILL A a,
J A B
BEN° ERAL PERMIT Previous permit # :X
)New —Modification -Complete Reissue CPartial Reissue Date previous permit issued �
rized by the State of North Carolina, Department of Environment and Natural Resources ' > A
�oastal Resources Com ission in area of environmental concern pursuant to 15A NCAC /y /zoO
mR ules attached.
it Name -( �( V A10 Project Location: County r DU
n/ Street
' UJ �Address/ State Road/ Lot # s)
State ZIP ? 36Utea S
:ed Agent
❑ CW
`f�'ITA ❑ ES ❑ PTS
❑ OEA
/'
/❑ HHF /❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes �n`o
PNA yes ' 10
Subdivisi n
City ��/� i ZIP 2�,
Phone # (T'— River Basin
Adj. Wtr. Bo Q/1li 4' �(natvP
Closest Maj. Wtr. Body
f Project/ Activity
ck) length
atform(s)
Platlorm(s) r
ier(s) air
d/ Ripr3R l�
distanced,
uc distance
cannel
sic yards
np
is oatlift �7i ✓�Z
ium: n/a yes no
yyee-sry o
kttached: no
ng permit may be required by:
I nral Pinnnina hiricrlirtinnl
V (Scale:
❑ See note on back regarding River Basin n

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �} biL oc Y re i I 's
(Name of Property Owner)
property located at V I `>rt
` (Address, Lot Block, Road, etc.%
on 3tunl o Jt nCA , in �, u +. -, I (')f)51L-XJ!) , N.C.
Naterbody) (CityIT6wfi anwor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
_ yA 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)
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, 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.)
Y� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Info ation (Adjacent Property Owner Information)
ign tore _ Signature
Oehh)e, Hor r-&IY Vin Garofano
Print or Type Name
M�aailing Address
fiu tit , k Ll L, S
City/State/Zip
3��cSs17 Szi:�Irit�r��e:1'u�rrt_il p SgtPrr'.
TPlanhnnP Numhar/ .mail arlrtresc «��
Print or Type Name
1801 Kenwyck Manor Way
Mailing Address
Raleigh, NC 27612
City/State/Zip
919.868,6286
TelPnhnnP NumhPr / Pmail artrlrPss

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to cw Y Y'd s
(Name of Property Owner)
properly located at
(Address, Lot Block, Rgad, etc )
on_�Q__. nUl in + CI1�1 / PM( Ur N.C.
Waterbody) (Cityrr6wh and/or County)
The applicant 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 fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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)
l� XA-rn
Signature
Il`hbtir 1-1«YY� � t
Prfnt or Type Name,
t oIUL ofl,
tling Addres s v
Ll t + C I +U -
City/state2ip
337,c. !R» s�ia�l is Y_____rrtll� sc+lem-
Teiephone Numberliemail address c�u
(Adjacent Property Owner yfation)
L
Signature*
Maili A es f_
city, tate/Lp
Telephone Number / emai7 address

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1��.1�1rJ\ �. Rc4 ry-W
Mailing Address: U
�uY-F CNuS
Phone Number: _� e6 7 a o1
Email Address:
I certify that I have authorized Jc-(LL-� i (ntf-"
Agent / Contractor
rI
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Vet,) 60u k L4-e
at my property located at Wr "�')t'rtc+j SLli(- C*A ,
in Pc'nA;,County.
I 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.
i phi le. 1-b v V-e I
Print or Type Name
CY
Title

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