68592D - Nashawaty

-CAMA / ❑ DREDGE & FILL
3AENERAL PERMIT
((New Modification ❑Complete Reissue
Partial Reissue
'8592 A B
Previous permit #
Date previous permit issued_
rized by the State of North Carolina, Department of Environment and Natural Resources
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC��.
) t ❑ Rules attached.
it Name I C��� 1L� �tn��,ja�-j! �i Project Location: County glws J a
iD 829 WO e.S �r Street Address/ State Road/ Lot #(s)
11\11 r_./ State[, ZIP Z 51 �1 16" ��r i�a tr ( -
` (9Li-) q /Z- 41 cif E-Mail Subdivision
:ed Agent LA vv 4&(m S City /4 /Cie ZIP
❑ Cw KEw 0TA xts YPTs Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A j,
❑ Pvy:
Adj. Wtr. Body �L��1L� (nat [
.aNe I �a Closest Maj. Wtr. Body WT(4j4J
r Project/ Activity
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rig permit may be required by: U0 I Ato (� ❑ See note on back regarding River Basin r
Local Planning Jurisdiction) _ i 'e- I

;,-vemor
North Carolina Deoartrrert of Cvlronmert and Natural Resources
N C Dwisicr of Coastal Management
AGENT AUTHORIZATION FORM
Date _�1-6 ^3
Name of Property Owner A ing for Permit J Name of Authorized Agent for this pl
Owner s Malling Aodress
Email y} / /
Agent's Malting Address.
190 , l ',
Email _ e /1 ri (A
Prone
�e",`y that I have authorized the agent ►tsted above to act on my behalf for the purpose of app
for and obtaining all CAMA Permits ne�cessa'y to install er construct the fotiowma (act,vi
For my property located at

P/ea f�p-
ell,
ok Job
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIMATIONlWAI
Nam* of Property Owner
Address of Property.
(Lot cu Street # Street or moat, Lxy s County)
Agent's Name 0: Z_,*,z� 6 /as MaihN Address _Z-1�6�
Agent's phone #: 40— </41 3' ,� ,�, , .n,y t . _ -[ A
MWI
c . • • •� • • w.jJ •�i • • • • •r .. :1 ..�.L^. • • • . •yy y:
� V-J`4 ,,�+(� I have no objections to this proposal. __ _ i have objections to th
if
yw have otycavas to *,not is
Nrfi�q wtihin ! 0 �n9 Pr��•�rl. !"ou awst nodfr the Afviaion of Coseisf a�Ys of rec-64W of this R0dCa. Coasspond•nca should bo 1 10127
Wftk . NC. I34054W. DCM r*Pr6"*lst V" Can Nso bo ContaCftd at M10) 794.7,
corrsAM $ do same es no ob¢sctbn N rov Ave. bon no~ by Carini*d AW
WAIVER SECTION
I understand that a pier. dock, MOWN pdsngs, breakwater, boalhotjse, rift, or Sr
bade a minimum distance of 15' from my area of riparian access ur*M waived
wish to waive the setback, you must initial ti-e appropriate blank below)
I do wish to waive the 15' setback requirement
t do not wish to waive tt-w 15' setback r
(Pcope— Own fPft i )
$ignrll ure
awe ./.Jd;�
P" or Tyoe Narno
• .� v
MA lit-

CERT�Ia�� � G iPT RE�IEarFn
DIVISIONOF COASTAL MANAGEMENT
L) Q
ADJACENT RRIAN PROPERTY OWNER NOT'FhCAT'O WWAtVER FORM
^p� k,3 .b h1. or P'roo.rtr owIPAnerlac ✓
j %e dCn�7 t Address of PropeM
(Lot of 5t7rs0
saver Of Roao. L- s Canty)c� ./
AqW% Name a. � / �8 y
Address -1 _! o
Ao.nt't phone a
I hneby MWY That I own Map" w to the ebovs Ma
applo'a for this Par"* hull dseor*W to ma as fho w, on tM aCacf�id plop".
ew �� e4op"J ni
that are propotrrng davahoprttarw
�✓rl`t �� I have no objeetions to this proposal
a d{ a W ,,j , kAl A 5 i 61-10TI t 9. I have objci lions to this proposal
to ~AP
w�iwh, rho d" of--wof VA "W'. r«�•.sr,.wryw.a wa+aco so I rta p,a.,, taus
Mort. Ne. as oa.ssae ocah np.a.e rtta„e, a w"a s. ,+tqr b to cambw ww &t
m„at0ered ask caret ae r awe Lwe Pe be `onam1 d if 17fm 7e6 r?t! ft ^�For>ss a
nertw t:.ate.e rdr.
WAVER SECTION
I uldarNand that a Owdock, rn M" pirW, breM,w� rp
bade a mhMmurn distance of 15, tram my area of boafwree, thl orO
"Oh to
W*tve the setback. you pW aPPfOPr4ft denk bb wow)by yt mnttute (I/ na yousat
do with to we" "% 15. setback reywrsrnen,
I do not wsh to warve Vv 15 rMbeck requwwrmw
(Pr°perl, Or"' %P'mtl J iAdocontP
r Inlprt)
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)Pe 7VttnM CAf L.13.f 7T
'raw or TWO Mane
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cab
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