69361D - Hayes

t 101 A C/ILMA / ❑ DREDGE & FILL S�S
;�ENERAL PERMIT Previous permit# A B
New ❑Modification IComplete Reissue El Partial Reissue Date previous permit issued_
)rized by the State of North Carolina, Department of Environment and Natural Resources nn ��
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC !J � R zoc o
it Name,
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Rules attached.
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Gcrm L ID u / r 1� cs
Mailing Address: 6 6� �Z2f / C �, �
Z
Phone Number: % l� �� ell,
Email Address: 62A ye S ,-D 11,1q?' !�� �✓9-t�l� ��
I certify that I have authorized 1-4x,
Agent i 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
ut
County.
I furthermore certify that l 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:
Jr?
Print or Type Name

SYA
I hereby certify that I own proporty adjaacont to 6 erm " .) _ryry (p r?pT m �qe
EC --
Property located at 9;„4 , �'► N j� /�- __ _r_ _o _a__
(Addron, UK �k, Road, etc.)
on / < liT , In wen/3 /i tf-i-G, �, N.C.
(4ftf tter&��t�yj � li ji�r�r_^gym Mndlor Comity)
Yh© applicant has described to me, as shown below, the development proposed at the abovo location.
I have no objectlon to this proposal.
I have objections to this proposal.
0(✓SCROPTION AMD/O."t MA WPM OF PI�RtOVOS19D IDEVELOP6?,2M. T
(jrndUVWV',d PriaPOWAII-q develepff�awB nakc�;g NU in 0AS" rdPU0fl h�-Inrpv nr aggech b W90 cn,`Ifewi/av)
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 roust Inldal tho appropriate blank below.)
_ �""A I do wish to waive the 15' setback requirement.
do not wish to waive the 15' setback requirement.
ib)xeo�
ram_ C�Irz a L N tA-1 1 r 1-� �-
Pdnt or Type Name
lIAAJIinN AiliJwae4
AMAW Promavily Ov nerr Infbvn- Jon)
J
Signct� e
Print or T
Mailinm rrns�rc

I hereby certify that I own property adjacent to , l� Ff1A � 1� � 14A-n &� AP 's
\ (Mrims of Prorsr�i nsrj
properly located at Z I J�„/ C"it bJ
(Addr eve, i o% Bloch, RovA W.)
on z eE ,in ,'ZIr- u z(zzIIc- teiet' W.C.
(rl aterbodly) (MV/Toturri andl r County)
Tte applicant has de scribed to me, as shown below, the development proposed at the above location.
(� I have no objection to this proposal.
I have objectionn to this proposal.
(MONVIdgal proposing da-Vol4.prooW rvu' R fill in ",-law or Morth M alto 01ratui-iy)
WARMER SECTIOM
i understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin roust be set back a
minimum distance of 15' from nay area of riparian access unless waived by me. (if you wish to waive
the setback, you must Irrittial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
-1 dry hoe wish to waive the 15' setback requirement.
(I�ro 1 OUVn4v InvoVM066n) (Ac1jncent Y-I-n-pny'�y Owner Infou"atrion)
Si matureSignature
evfr �tv Grrzoan
Print or Print or a Name H Iq C'5

8/4/2017 BofA 4627 $200.00 GP 4608D
PNC Bank 6475 $200.00 GP 69362D
First Citizens Bank 5831 $600.00 GP 69343D
PNC Bank 6487 $200.00 GP 69378D
Elizabeth Easley Wetherill
George Brake
8/4/2017
F and S Marine Contractors
Susan Gross
8/4/2017
Allied Marine Contractors/Hal Fogleman
Todd Christiansen
8/4/2017
F and S Marine Contractors
Craig Goess