69397D - Strickland

CAMA / „DREDGE & FILL ID ' � A B
3ENERAL PERMIT Previous permit#
New 7-Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources 67 ( , //() o
:oastal Resources Commission inanarea of environmental concern pursuant to 15A NCAC ` ❑jtules attached.
Name 1 1 e �t! (L �� Project Location: County i��/O&J
Street Address/ State Road/LLpt #(s)
/ ✓P State NL ZIP-ff--
��n Subdivision / G
ed Agent City �!//!(� -� ZIP 45A
❑ CW )4EW PTA ,A,ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS
yes /k� fi PNA yes
r Project/ Activity
ick) length_
atform(s)
Platform(s)
angth
amber
y;Riprap length
g distance offshore
ax distance offshore
ibic ykds
mp
use/ Boat
Bulldozing
ne Length
not sure
yes no
>rium: n/a
yes
yes
Attached:
�es�
ding permit may be required by:
Phone # ( `�—' River Basin
Adi. Wtr. Body �'�A/� natt
Closest Maj. Wtr. Body
(Scale: /
❑ See note on back regarding River Basin

I" z I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ep, I e 7/i� citl� s
� V �j� (�� e of Property Owner)
property located at 7
/ / (Address, Lot, Block, Road, etc.),
cS i' C on q,*, , i n fU�' A 7, , N . C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
" FKar �f� l
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you w to waive 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 ormation)
PrC%iTYPe� �/ I i�0/f� Al
A Inc
(Ad' It P erty O er Information)
Si nature
Toi•, ..: [ 1-. & e
Print or Type Name
20 `l0 Tr.-;n Milt

T RIPARIAN PROPERTY
I hereby certify that I own property adjacent to e ti ' C lu s
/ // ( a�'o'f Property Owner)
property located at tell � (f SlJrF C, t:(
(Address, Lot, Block, Road, etc.)
on �01-6t[ , in G (-' lky N.C.
(Waterbody) City/Town and/or ou ty)
The applic nt has described to me, as shown below, the development proposed at the above
locio at .
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, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
l� V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner I formation) (Adja nt Prope y 7wnr Information)
si7Sture,e
PS G l� 4E^
PTt o T� e Pri Type,Name.'

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized P- ` '
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:��/G°�/
at my property located at
in f�� �s (# w County.
I 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.
Property O,y 6er Information:
Print or Type Name
Title