69412D - Pullen

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�CAMA / DREDGE & FILL ,, I 6
� A B
r"ENERAL PERMIT �`� Previous permit#
New Modification ElComplete Reissue Partial Reissue Date previous permit issued
wized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (-
it Name �2�t) �t � 1 11 n
2000 W bra INTod M
I(Ac �j�req StateNL ZIP 27SJ
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1 ❑ CW �Ew PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / PNA yes / 1
f Project/ Activity _ 1 t)( a (L ty S
>k
ach �'n Rules atted.
Project Location: County / �y G(,{'1 cy f V
Street Address/ State Road/ Lot #(s) '4e& j1l, C
r1VR
Subdivision
city �"�ightSOIU 6m ,i� zip
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ng permit may be required by: OJ&VI Of (Jb yf W V J-K XJ I U DOal ❑ See note on back regarding River Basin r
Local Planning jurisdiction) - -

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: I` {' l �« Ile,
Mailing Address:��i���rr�r l I�•yI-daz;:�. J/�f
Phone Number:
r+
Email Address:��i�T'
r,
I certify that I have authorized A,
Agent Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ll "�; �fT 1�3 i t for
OLIL-
at my� /property located at
in /Y `r'� �j; +'''v County.
1 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.
Z
Owner nformation:
f Signature
J7� i U )V
Print or Type Name
Title
Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVFR FORM
Name of P Owner: �l� I; I ,�/'
el Address of Property. �rnA114,04W >
(Lot or Street #,
Agent's Name #:
Agent'sphone# _j�1` mil' ✓�f
or Road. City & Courlfy)
Mailing address:''
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
1 have no objections to this proposal. I haw «itjeCtiuns itt diit prop(sal.
lyv: Z�vobjecWns to what is being proposed, you must notify the Division of Coastat Management (DCM) in
writing within 10 days of receipt of this notice Correspondence should be mailed to 127 Cardin) Drive Ext.,
Wilmington, NC, 28605-3845. DCAN representatives can also be contacted at [phone]. No response is
considered Me same as no objection if you have been notiried by Cerbrred Mail.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, lift. or groin must be set
back a minimum distance of 16 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 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(P Owner I n
�ffi�r!�r1i!Ycy
J,41,
Print or Type Name
Mailing Address
CdylState24)
(Adjacent Property Owner Information)
t
tattrrc•
Pant or Type Name
Mading Address
Mai fff3lqd
0ty1S1a1&Zip
rAA

',eMAp4gCeNT RipA o/vISIO RAT �Rk RFC
eofPr Rlq�yp NO C 1p�
e ��� ROpERYAST4h1 RE VEST
Addr ss ofPrOf�eo4lrner- � � �:� `�` OWNER' ARq�FIa F�
f���1TlFy, FNT
Age is N y'r'}y.� �' �ON
n
am n '' I, r
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t' a �t --; otA qIV R o
Ben � Qr
f1fi F RR?
cihla
Aty Cett!/�, t IS 'Qd0'rems
t for thi _ �1 i-
�eArnp ernhas Arpp 1.2
• -+sr 9 A Scry des ;b�ao'i�nt
1 hat t'°n to rn tO the ab
ya a no O3 icc - dm++'in a as st<osz n oVe ref =
ai��� to mar t�s to this � f � d;me��o� fi�h� raw.
aT
41C moo or '�4% ust be wrn9 the
Of
he indi
sa, as b t?C,� n�roAa;�` t hat t r►(1�ti,d�rS oAdL*nt I
if bra pan `��r1�, �"Is to
t ft tettef
�d that u �a a1So l'st r''�s'ounor r� prop,
a aecO`�T�i
Iimlim dts f� dp�k 'odd c CO.!*&,Mans
Ile the nCe Of y !nq�r ng �'At y�rR S eA e`°`,yal(9j°f lb r
9�� �ntroorcr
�Gk Yous from mpJlrr�s br SEC Zee ?'S No °��e ��
` t do wish t0 w � t irli mi.of ��ntac �,,, pose jS
AroAnate b i unless lift ol9roln
aNe the 1
5 Setback r ank be fO� wa,- r
! do nOt vrsh to
wai must be set
ve the i3. e4uirernent. Y me. (if YOU
Soback,s
r1) re9ts;reTnont
(Ad1ac nt o
Pro
ne tnfor CA
ro
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