69347D - Kennington

�2kCAMA f ❑ DREDGE & FILL ��15�
` A B
EN ERAL PERMIT Previous permit #
—Alew ❑Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources +
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC of f (�1 DC,!
❑ Rules attached.
nt Name f 4 Y1 ' Project Location: County ��M ( Rule('14 C
s Z�' a �— c- � - Street Address/ State Road/ Lot #(s)
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f Gt �`��� A State ZIP_�),5q 1:1 (c) �!^ 7 Ill ' n m o�11�J
It X— E-Mail Subdivision --------
zed Agent - City n IQ if R i ZIP
d ❑ Cw I LTA ❑ ES ❑ PTS Phone # ( ) River Basin_ L(/w
ElOEA ❑ HHF ElIH ElUBA ❑ N/A Adj. Wtr. Body w W ,S j CyCt at,
❑ PWS:'
yes / PO PNA A / no Closest Maj. Wtr. Body ( i
A Project/ Activity
ock) length_
'latform(s) _
g Platform(s)
length
umber
ad/ Riprap length
vg distance offshc
iax distance offsh
channel
ubic yards
imp
)use/ Boat
ne Length -t•- 10 0
not sure yes ro
)rium: n/a yes
yes
Attached: yes
(Scale: ' � �
ling permit may be required by: Q N^'� IJ�� IJt'�L �% ❑See note on back regarding River Basin

14
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I hereby certify that I own property adjacent to Grad
property located at
on ZC
(Waterbody)
(City/Town and/or County)
's
The applicant has described to me, as shown below, the development proposed at the above
location.
1E 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)
f/ �f
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I I 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.
(Propertw e nform tion) (Adjacent Property Owner Information)
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at l e Si ature+ B2 1;�W( '
P1%r T ��e P' t orlpe y�✓19 -
0 A,A tA f

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I hereby certify that I own property adjacent to U-T" N ( � s
property located at
on iL /
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to io�
rrr" 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)
I— 1
1
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 w' 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.
(Propem O er Information) (Adjacent Property Owner Information)
t nature Signature* ,�
der Wells
t 4b Tba.
�Itfl G - Pion r-P egV / 4 -1

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: 4107 Rtf-A ta—, r tfl �
Cs Tn.j- "- nJC zh'ds
Phone Number: /%((- `foci - oor?-6
Email Address: C 2fDy EVILS K Co h
I certify that I have authorized 31 � 5 TRU e-7-r o v
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: a I f'R
at my property located at 1 7r4
in County-
/
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 Owner In ormation:
gnature
Print or Type Name
Title
—.7 1- 3/ 1(Z
Date
This certification is valid through I 1