68558D - Riverside

�CAIWA / DREDGE & FILL �'t+ `�� "-.1 -8p QQ
3"ENERAL PERMIT ��,1 Previous perDm� Q A B
)New -Modification ❑Complete Reissue El Partial Reissue 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 15A NCAC T .
Iloo
I1,,❑ Rules attached.
t Name /S; dC �J ►c �+�C.. Project Location: County .r
(o� ITTC��i _ Street Address/ State Road/ Lot #(s)
State ZIP 8� 0 (,9 (J . )4
3 ' yy-Mail Subdivision -"
ed Agent _IA y d Loyo r City—' xaA.,pacl ZIP 18,41
❑ Cw ❑ Ew ❑ PTA 0 9ES ITS Phone # ( ) River Basin C r 1Z
❑❑ OPEA ElHHF ElIH ElUBA El N/A Adj. Wtr. Body �F 4
nay i
yes no PNA yes / no Closest Maj. Wtr. Body 2-
Project/ Activity 1� tP (A(Q f7y S F i1 \.e 4/ (k
:k) length
itform(s) _
Platform(s)
igth
nber
Riprap length
distance offshore O
x distance offshore
cannel /
)ic yards
ip
se/ Boatlift
(Scale:
IL
■■. NEE �C.�rn�C■■■■■■■■■■.®■..I■�■..■......■..■�.
•

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: D!'r\f1 S 1-4-f-'2M tlj�
Mailing Address: (0(a Ihi . e8�:j
Phone Number: 1 b L4 L-1 S L-1lAq C�
Email Address:
I certify that I have authorized David Logan of Logan Marine, LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
6-ae ,:�r N-evj 801-\Z- l-tc- �
at my property located at 101 'W . 6&'-1 ST S
in R(ZUM,;y he _1L. County.
I 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:
Signatu e
r~5 BL_1101"
Print or Type Name
O v�+f�liE�L
Title

■ 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:
so"YTIAIF'0�rv_ I
,. (. Za-1b I
IIIIIII'I IIII IIIlillll IIII II III illll I IIIIII III
9590 9402 2978 7094 5965 05
A. Signature
11
B. Received by (Printed Name) I C. D
_ _ I
D. Is delivery address different from item 1?
If YES, enter delivery address below:
❑ Agent
❑ Addressee
aof Deft Very
t1/ Z /7
❑ No
in
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
❑ Adult Signature Restricted Delivery
❑ Registered MailTM
❑ Registered Mail Restricted
❑ Certified WHO
❑ Certified Mail Restricted Delivery
Delivery
El ReturnReceipt for
❑ Collect on Delivery
Confirmation"
Delivery Restricted Delivery
❑ Signature
2. Article Number (Transfer frnm moo^ ' Mail ❑ Signature Confirmation
0 910 0 0 0 0 6063 8463 — Mail Restricted Delivery Restricted Delivery
7016 -- -
PS Form 381 1, July 2015 PSN 7530-02-000-9053
■ 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
C) L)ti �N2 I L.L(
5 i'oc� 1.N C T9LA 61
Domestic Return Receipt
COMPLETE• ON DELIVERY
A. ur
X ❑ Agent
❑ Addressee
Received by (Pri e) C. Date of Delivery
D. Is der' from item 1? El Yes
If Y ent delivery address below: El o
3.
1 ��
rity Mail Express
I
I
I IIII
III
II
I II
I I
I
III
(II
IIII
(
❑ Adult Sign a
Sig
egistered MaiITM
d It
❑ Adult Signatu stricted Deliver] 3
Registered Mail Restricted
❑ Certified Mail®
Delivery
9590 9402 2978 7094 5964 99
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
2. Article Number (Transfer from service label)
❑ Collect on Delivery Restricted Delivery
❑ Signature Confirmation—
il
❑ Signature Confirmation
7 016 0 910 0000 6063
8456 it Restricted Delivery
Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt