69088D - Pigott

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AMA / -- DREDGE & FILL
GENERAL PERMIT
XNew -Modification LJComplete Reissue -Partial Reissue
A B
Previous permit #
Date previous permit issued_
>rized by the State of North Carolina, Department of Environment and Natural Resources �7
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 60, 055gd ly /4JAGO,
ElRules attached.
itName �� i L AN V, koff
Project Location: CountyyVl�syya K
Street Address/ State Road/ Lot #(s)
YY1 tyNv\ State.(. ZIP
fjv) `nb —1/ 0 E-Mail Subdivision
zed Agent IT N L- Citytr
ZIP
CW AEW WPTA ❑ ES ❑ PTS a one # (q 1 D )a^1�- d $ j River Basin
❑OEA ❑HHF ❑IH ❑UBA ❑N/A �1
❑ PWS:
yes / 6o) PNA yes /
f Project/ Activity
-I.
-�
)ck) length V 1
_.1S-Li
latform(s)m
—S Platform(s) �i--
:ngth
ember
d/ Riprap length
g distance offshc
ax distance offshh
hannel J
bic yards
np
ise/ Bo
e Length
not sure yes
ium: n/a yes
yes
kttached: yes (d
ng permit may be required by:
Local Planning Jurisdiction)
IN,)
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.,
Adj. Mr. Body lA U ?M iat�/
Closest Maj. Wtr. Body wyJ
w
(Scale:
❑ See note on back regarding River Basin r

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: W Ida- M Pjav4+
Mailing address: 3gAf I H&I -Fax Roa-d-
W I 1! 4v , N L .2 g o3
Phone Number: q l �� L f 1 D -1 t A0
I certify that I have authorized Mi' K U% ,
Agent/ Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 0.. &Joe k
at my property located at L (,0(o Wl IQae Po%'t leaf SW S
in &UnSW1`Gk- County.
This certification is valid through
Date
(Property Owner Information)
(100A)
/� nSig ture /� p _ L t (/� p
i l' Q- M r ' / V �atr 1 t 4� OTT l�C r� � POA
rf Print or 73fpe Name
�a.�G�l-c►�
Title
c NL 4-1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _� JJ. W , eo.
ert Owner)"
property located at _ fG /4 vu ���.� ,Q�L (Name of Po ,�
(AddFess, Lot, BI ck, Road, etc.)
on J--'k�in , N.C.
(Waterb dy) (City/Town and r 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 attach a site drawing
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bac
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w,
the setback, you must initial the appropriate blank below.)
! do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adja e t Property Owner Information)
Signature Signature
Lit P1 , o Pi r✓ PoA
Print or Typ am Phi t or ype Name
(i fax Qoo oC-

rell, Sean C
n: Mary Kerr <[e-mail]>
,. Monday, April 17, 2017 1031 AM
Farrell, Sean C
ect: Docks
jean. I am power of attorney for my mom Hilda Pigott @ 1606 Village PT Rd & representative for The
ling Water Company @ 1614 Village PT Rd Shallotte,NC. Fiduciary for McKee Pigott. Thanks. Mary
►tt Kerr. Have a great day.
from Yahoo Mail on Android
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
A. Signature
X' �.
B. Received by (Printed Name) C.
D.. address l ftV item 1?
«{f,,,l'ES, enter delivery address low:
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III�IIIII IIII I�IIIIIIII II�IIIIIIIII III IIII I III 3 deINSig Sigice nature '�H11 ° Rregis
kAdult Signature Restricted Delivery ° Registr
ertified Mail® Deliver
9590 9402 1661 6053 1752 07 ertified Mail Restricted Delivery ❑ Retum
Merch
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Collect on Dellect on ivery Restricted Delivery ❑ Signati
7 016 0 910 0002 1223 6479 Restricted Delivery ° R�i�
PS Form 3811. July 2015 PSN 7530-02-000-9053 Domestic
See
rery
--_ icted
nTm
in
ipt .

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to H 11616 M PI Acit I
Name of Pr erty Owner)
property located at OL V l (A e Ppj�-�- 0 W
on �k,((o-++e- Kjyey (A dress, Lot, Block, Road, etc.)
in _ Shc�I 10 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above iocatic
vplI 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)
WAIVER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bac
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wa
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
r o.
Print or Type Na e
g i HAJ, �&x 120AVL
Signature M'
cz � Vv
Print or Type Name
A d..a:-- A - -

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