69466D - Moore

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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 12 1 Z, I i I
Name of Property Owner Applying for Permit:
—Yzf, TK alb S. MOGeE.-
Mailing Address:
I d I COAS'-A t, ?.?W GFS i
AAM pS-t''�-A D , r,JC
I certify that i have authorized (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) A�al 1-11)e-/-
at (my property located at)
This certification is valid thru (date)
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (STI �� S, bt/1 Ode - 's
ame Property Ow r
property located at �ei ( CON�T�L �{�{,(P5 r 111 �'�j'(�
Gw (Address, Lot, BI ck, Road, etc.)�-'
on in.14/(` TSAt N.C.
(Waterbody) (City/Town and/or County)
The applicant has describer} to me, as shown below, the development proposed at the above
location.
0 J�— I have no objection to this proposal
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must f f In description below or attach a site drawing)
57-
(�(-KOO �Zt Y I Z"
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or gran
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (It 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.
Information)
Print r Type Name
� ot,� (,;o�Ac�A3fuc
Mali
ciry/s telZip
aZ-}-g3c,�t
Telephone, Number / emad address
Pare
'A/ HA f—.,.,o —1o. q—„oar �Ff—
(AAd ceentt Property Owner Info ation)
�. T '
Signature •
I- IN Tb/d L L, !v1 NA,
Print or Type Name
5'3 KtN4 t T &V C.ye,c-Ct, `
Mailing Address
Ct K E= 0,0.1 s
c;tyista�e�zp
'? 3 G 40 2- t L PG
Telephone Number / email address
/.2- )1- /7
Dare'
(Revised Aug. 2M4)

I hereby certify that I own property adjacent to r,2�i[Zi �l �f S . RAgo e � ,s
property located, ly ( Ci5t AL `✓t/vt� oC-T werty Owner)
on etc
('iVJW (Address, L- in�,ma AL , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
2 I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAMNG OF PROPOSED DEVELOPMENT
(lndvidual proposing development must fill in description below or attach a site drawing)
�wA t t t1 DoC� Cgl �C Z
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 }
{. C�-- I do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement
Is-
3
•\/dirt fn. nno rolorvl-ar vn�r �Ror c.nr, ol��rn
SigrratI
Print or Type Name
33r A'en "S t
ma*j
Ciry/St8rc -'p
Telephone !email address
/ l3 /7
Date'
(Revised Aug. 2014)

12/14/2017
Pilings and More/John Cassidy
Frank Barbieri
First Citizens Bank
8243
$200.00 GP 69433D
12115/2017
Carolina Marine Dredging, Inc./Mike Cone
Kenneth Boras
First Bank
1240
5200.00 GP 69419D
12/18/2017
Norman or Terri Pippin
Kristine Moore
Wells Fa!go Bank
8984
4603
2317
18773
acaaz
_
$200.00 GP 69466D
$200.00 GP 69394D
$200.00 GP 69451D
$200.00 GP 69459D
i tdnn hri i na aoaasn
12/18/2017
_
Mark Clements Marine Construction Inc
Sean Walker
First Citizen Bank
12/18/2017 Adam Knierim/Maritech LLC
12/18/2017 Carolina Bluewater Construction Inc
12/18/2017 Norman or Terri Piooin
Michael Stonestreet
incent & Karen Barilla _ _
Kent Yarhorounh
B of A
BB&T
_
Welk Fnrnn Rank