69305D - Troth

,D `,%.15.0.'k
1CAMA / ❑ DREDGE & FILL 1D
'
P" 5
%E E L PERMIT
Previous permit # A B
�New odifiti
reStratAf
o plete Reissue CPartial Reissue
Date previous permit issued
-ized by
;oastal Resources Co
�i t�
rol a artment of Environment and
in
Natural Resources
15A NCAC
mission n area of environmental concern pursuant to
d
��►"�j`��.�
Rul attached.
t Name-7
Project Location: County��i(/�.
1/ -1c P, s ti' �/
_ T? CI
Street Address/ State Road/ Lot #(s)
Statel�--ZIP
E-Mail
Subdivision - Ili%
ed Agent A/ ��
f
City �"V, 4 C � ZIP
❑ Cw &EW ETA ES ❑ PTS
Phone # ( River Basin
❑ OEA ❑ HHF ❑ IH UBA ❑ N/A
7
Adj. Wtr. Body -^JA"7i
❑ PWS:
,�/Lr
yes PNA yes /,/no
- A
Closest Maj. Wtr. Body I��t �td6X�
Project/ Activity W1 j 9 ,
f tw
(Scale:
:k) length
orm(s) FFI
igth
nber
i/ Riprap length
distance offshore
x distance offshore
annel
sic yards
ip
oatl
not sure yes /' now.+__i_
um: n/a yes (no
yesLn,o
,ttached: yes �j�_
ig permit may be required by:"7
.ocal Planning Jurisdiction)
❑ See note on back regarding River Basin rt

Name of Property Owner Requesting Permit:
Mailing Address: '�; 5 � � 6-y 66;12,ro
u).a�.A(- 2931
Phone Number: --7 0 q- 72.'r- >> I I D
Email Address:
certify that I have authorized" fis P IVZa /7 f ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development:.y'4
at my prope located at
in 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:
Suture
Print or Type Name
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to _ ' CA —
property located at
n (Na Property Owner) r' t 0 S 0 `
(Address, Lot, Block, oad etc.
on , � ,� �� in i 1—, N.0
(Waterbody) (City/Town and/eir County)
The applicant has described to me, as shown below, the development proposed at the abov,
loc ig�
�j�-- I have no objection to this proposal.
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
M,
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groi
must be set back a minimum distance of 15' from my area of riparian access unless waived b
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(P rty Owner Inf mation) (Adjacent Property Owner Information)
�R� f l7`(�
l S - po.
AjAatur G�zgnatuf �e

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -7—roi-i-� a R,cjj J e,, is
(Name of Property Owner)
property located at 1 i !Q. A-�-k% ,,, s e.-• pi>
(Address, Lot, Block, Road, etc.)
on,, fir, jc�c.o4 J in+� N.C.
(Waterbody) ( ity/To and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location,,-'"
v ` 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)
#L r
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
r erty Owner Information)
iA—&(
�—)�
VnaturP�� T�
Print or Type Name 1
64'ro
AA,.r,.,. n
(Adjacent Property Owner Information)
O �a - ----�
Signature
L Q
Print or Type Name
7,5 5odee14,-2d�Y2,

ADJACENT PROPERTY
STATEMENT OF
NO OBJECTION
I hereby certify that I own property adjacent to I po " a- C T2 O-T� 's
property located at i
(Name of Property Owner)
I-7 (0 n s cv%I- `?�
(Address)
on ► o Sa i ) S o L) • -\ d in Surf City, N.C.
(Waterbody)
He has described to me as shown in the attached application and project drawing(s)
the development he is proposing at the above referenced location, and, I have no
objections to his proposal.
IC' (o b 34-S4
gnature �J_' Phone Number
PPn%nSL�k�AI
Print or Type Name
o hn 1�011)
pcf J 3 ae -- os' 2 7
Return form to:
NCDENR
Division of Coastal Mgmt.
127 Cardinal Drive Ext.
Wilmington, NC 28412
Date

ADJACENT PROPERTY
STATEMENT OF
NO OBJECTION
I haraby cartify that I own property adjacent to < Ps ^ 1 a . Alt a-T+� is
(Nom of Property owrW)
property located at..�
(Mfdrmwr)
or) in Surf City, N.C.
u (WdArbndy)
Ho hears dow rybed to mo aR shown in the attached application and project drawing(s),
the dovelopmont he is proposing at the above referenced location, and, I have no
ob actions to his
Signature
Z-Alrh iJ - �CC� we
I ► ►'1 %c.h A e I Tl _ fi .4 m 14
ar1nt or Type Name i
l_o+ 0 Z3
fe-yl1-nsv IA (A+ t,, totsAt
S�,e � C rr
l N
20-7 21-)0 334�
Phone Number
Return form to:
i I 6%Z0 1%
Date
NCDENR
Division of Coastal Mgmt.

om
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