69360D - Merritt

CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
,New ❑Modification El Complete Reissue
❑Partial Reissue
�41 L.,
Sf� A B
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
;oastal Resources Commission in an, area of environmental concern pursuant to 15A NCAC Rules attached.
:Name UV 1 e11 1Q � /V ►YET i Project Location: County NN� t( Fl i i'1 uypK
232C� �(,�qL,j j�✓1 Y C Street Address/ State Road/ Lot #(s) V
Lug N I U j '' State��V� ZIP1
—r
E-Mail It;i di t e n iA hi e,-lt4`ttiok• Wfubdivision
ed Agent � fQ *1 Cary (,Aka' hu r7 GEC' t ZIP 2 L 2
a-� 1•
El CW qu EW )(PTA ❑ ES ❑ PTS hone # Aqq.q. River Basin A
❑ OEA /❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body M 11"",, 1k at i
❑ PWS: ltiY�
/''� Closest Maj. Wtr. Body
yes / ice; PNA yes / 'lY"
f Project/ Activity
,Lit)'
ck) length
- _- __ /_\
t2e tnn uwt sKrIT* ��i. " i I) Gi(,��1��1'y�r� -FloGtflv�cj G+lc��
ne Length% i
not sure yes o
>riunn: n/a yes
no
Attached: �-s no ` r
ling permit maybe required by-T t !f i%r%Wa �QW1, ❑ See note on back regarding River Basin
t'J-

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-+(rtt C Y 4
i
Slb�t1,a'<
Lot' 3
I
RECEIVED
DCM WILMIN ,TON, NC
JUL 2 a 2011
I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 0 R t ( .. 0<--- iry1 ' 9-cv, v,;1, l S s
(Name of Property Owner)
property located at (1 C A Xv � � �
(Address, Lot, Block, Road, etc.)
on Cft L -,o, 13c.w-L, i3o'41-
_l 'a*s oli , in rt4-%^o f r &,t- , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locati
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 aftach a site drawing
DCM WIL.MINGTON, NC
JUL 2 4 2017
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bay
minimum distance of 15' from my area of ripariari access unless waived by me. (if you wish to w,
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) (Adjacent Property Owner Information)
Signature Sign ture
Print or Type Name Print or Type Name
Mailing Address, 1 _ , , _
Mailina Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (L) ; l k� "-, i q , �,1�.�..; j 's
(Name of Property Owner)
property located at �� 1 � C A �; � i � rZ
(Address, Lot, Block, Road, etc.)
on Cahn I,,,,,� I�ca,=.�� 13'�Joi }— 1341 in 1 14+- („c� �nc� C% N.C.
(Waterbody) (City/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.
utbGKIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
-3ECEivED
DCM WILMINGTON, NC
JUL 2 4 2017
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
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) (Adjacent Property Owner Information)
Signature Sin ire
Ci� s t � . t}'lM �� � I � � c Y2 (,� i i(�' C► cso.rl Q S.i�SI..V`,
Print or Type Name Pnn or pe Name
Mailing Address . , ee„r,.,,, n.rr.,.�

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: j J i 1 A M! • 1/±� z �'' '
Mailing Address: �,3 2 5- 13:A y s: a
Phone Number: f'(f t� : �`(l _ 10
L
Email Address: 1 ��*� w C� 1=�4� �+� •1Zr
I certify that I have authorized ��S c� I_l•¢
Agent / 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
in /Vc., 14 County.
1 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 Information:
R /
t
Signature
Levi 11 �{ r..i 144_.
Print or Type Name
"IEC-LIVEr,
uCM WILMING'TOv, ar,
iJ "A-:'t---CI"Z-
Title
JUL 2 4 2017