69058D - Leth

IMWlA ddr:dlmm =!
smk Z=Tdq�■I

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: � i�l NS �E T
Mailing Address:
W
Cfxke
Phone Number: 6C76 -�f2 Li
Email Address: L>`1 �;"�D Lc/ (�M�� Conn
certify that I have authorized��/`�',(�
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: Zeeli f`
JQ� � 2�^^ 4 g l ,tom Z�za AD;� 117/ P/� %� iC �i 7y► /,1!'C�G�
at my property located at /�L�, �' o f�d7 e��
in 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.
Property Owner Information:
Print or Type Name
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 5A M es d-- A i ti' ati be s
(Name of Property Owner)
property located at (oVRTl �bl 0 T CI R.c LF S f.J
(Address, Lot, Block, Road, etc.)
on A0--A-u%Ocb Flo %u✓,-z in , N.C.
(Watertiody) f ( ty/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 rill in description below or attach a site drawing)
b / X / b ` 6-�o lD a A, T ..o t oG
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)
i ature
AM€� tiET//
(Adjacent Property Owner Information)
Signa# re
qG.F T / U� V
Print or Type Name
1, 9, M v2-71 -- ri),., I C►K1 I e 5�
Print or Type Name
P *) /►M ;/ e-' L-:z Ian ri— i - <f-

ff,e"ty /f
6bb5 Ven f yc(Cs LGG
y � zgy6�
t �3� Ib
(�Prfox 13,
(oo�
l
3W
1 L�
�-�rea�
%4 �ACW4-� be i�> �'�I.
/ a /6 �C/6� p ler 4o be- I
x 3` JOLOy "Itl
/6
�1$ �etrS�lled u5+rg Ac°v�
2VW2-
dahia9ea0Garea DK rracti W

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to J �,� l c`�s J,iiy x %j�� 's
(Name of Property Owner)
property located at �� ,�1ivr?� �D116I 4'1/7,C .Si� , SyeL4/ N G °�� �z 62
) _ ✓� (Address, Lot, Block, Road, etc.)
on / 061kc c?oab Fyt �y l'�1✓e/Z —,in SUP!'l.s/ , N.C.
(Waterbody) (City/Town and/or County)
The ap licant has described to me, as shown below, the development proposed at the above
locati n.
I 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)
0 ©N 4e?((S/ /x
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.
(Pro erty Owner Information) (Adjacent Property�0�wnrInformation)
7
S 91�9
,/�))��Si `l flMes �, T/i S!��k,7K 41X_ f t/ %�W
Prit or Type Name c Pt� o4ypeV)1n ,n j
6 ! 2 Mvr i l_r' ,A 1 c )ilr h Lt. S 4 /y't etti 'l�Kr� !�[

�1 ,►,Gg��P g. x16k /ergo be
/6 J
�,►�U ed x 3 ���w, y Val
`x 8 ` Pt oaf r
14 Il $ SP us►rg Ae�
e�Mot
ti W
Pier �, ►�- re,�
I
ff,e,ly /f
66bs VeA1-pt(e,-,Z1C-
fic /,;W,
S��P�y �Jc- 2�y6Z
P14��e Point Gr. Sb�, Supply, rJC�