69310D - Strickland

F
CAMA / DREDGE & FILL A B '
1ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue [:]Partial Reissue Date previous permit issued
zed 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 (j /Rules atta5hed.
Name C'�+ t " Project Location: County
L f 44 . ' 4)A 1,- c- R5-- Street Address/ State Road{ Lot #(;)
y State CiZIP '
Mail Subdivision
ad Agent
Qom✓/' /!2- . City '� L4 G' ZIP
❑ CW W A ❑ ES PTS Phone # ( _ River Basin_
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A 7Adj. Wtr. BodyEl LJp�
� Closest Maj. Wtr. Body 27
yes / PN/Y� no
Project/ Activity
MOW-
!ngth
amber
id/ Riprap length_
g distance offshore_
�,x distance offshore
ha&el
ibic
mp
use/ Boatlift
ne Length
not sure yes
>rium: n/a yes
yes
Attached: yes
(Scale:
V. Cling permit may be requAd' � J U� (/ Se e note on back regarding River Basin
on back regarding River Basin

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to
/' �% � (Name of Property Own�r)
property located at (O,S %� ,` C h �, n / y f ; - - �- ,
(Andress, Lot, Block, Road,°etc.)
on h , in
(Waterbody) r N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above local
1,� 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
l0
X \fin
q'i 1�=
r
WAIVER SECTION I ('
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bag
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to m
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)
n /i/), /ee Offal
Mailing Address
,S e i ell
rgnature
T--, s e-e
Print or Type Name
`�rtA-5'1-.l h ., ze e 1P.r/
Mailing A dress

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
property —Y �5�1 U/] � 7L )Namd
o� c Property�owner)
located at
(Addiress, Lot, Block,Ad, etc.)
on / �>' ��' �re e A , in N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locat
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
1�
�X
�U
Y'rk,l l I' I�
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
trroperty Uwner Information)
Signal
I �n
Print or Ty0e Name
Mal"h Address
(Adjacent Property Owner Information)
�k-zl�-
Signature (J
Print or Type N��
Mail ng Address
/ /z /Ylla�

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
at McCrory Braxton C. Davis
Governor Director
John E. Skvarla, I'
Secretary
AGENT AUTHORIZATION FORM
Date:
ime of Property Owner Applying for Permit: N me f Authorized A rrt for thi roject:
Nner's Mailing Address
Jz, 4oldLe Li(C�gn
/%D 9 -Ga�,� �Tvh•%eP Rd
S /l/, c • Z�7�
lone Number
Agen 's Mailing Address:
px Z
Phone Number (i f O
;ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
r and obtaAing all CAMA Permits necessary to install or construct the following (activity):
i� I
or my property located at
his certification is valid thru (date)
4*-' /Z -/7
Property Owner Signature
Date