68553D - Williams

CAMA /&' - DREDGE & FILL �i ,L-rI'► s �rypC
3"E N E RAL PERMIT �� Previous permit it A B
-New Modification El 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 J 7�-
❑ Rules attach d
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ig permit may be required by: ( piy �S (a 118 ❑ See note on back regarding River Basin rt
_ocal Planning jurisdiction)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: (,j 1y\ W 1\ k 16U-V-'�-s
Mailing Address:
Phone Number:
Email Address:
q W h %-te_ Lin e
00tic. IskarNC4 " tv 6 Zg 4&5
Clto qa-C) SaSt0
I certify that I have authorized Mc?v\e —srn W, � r\a_ SPw' ces , `TGS5e., W�*Ie``
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at �I Wy\ i-�e L.Airit ,
in 3rvuT_-Av County.
1 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:
Signature
Print or Type Name
Tilln

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner_
;address of Property. � W hi +r- Lkn #- O(A lc l Stag ,
(Lot or Street #, Street or Road, City & County) �} t�
Agent's Name #: l A-�� �'� Mailing Address: l �i N- �"r 1`i t i' e,
Agent's phone #: 4S:m4NC- 294(ol
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.
U11Z I have no objections to this proposal. I ha,.e objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Krilmington, NC, 28405-3845. WA representatives can also be contacted at [phone]. No response is
considered the same as no objeQfion if you have been notified by Certifiled Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
OVT -L-7 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Property Owner Infor on) (Adjacent Property Owner Information)
�gnature Signature
Jim W i l [ i Arv-'S L..a-t iyerl e- ->:- W i 11 i a.k'-' Zc�r�ncx3-�
Print or Type Name
Print or Type Name
Meiling Address _
7
jfli ing Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner. t VV\ V k r a'Y1.5
Address of Property: " 1 Vqht�e_ L-6''^e— 'i'iCiS�'�C� gYUt°�Su►�i I�
(Lot or Street #, Street or Road, City & County)
Agent's Name It
Agent's phone # O � 4110
Mailing Address: wl Q. rrfvw�G
N t 2314tol
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_
zx_ 1 have no objections to this proposal. 1 have objections to this proposal.
If you have objections to whatis being proposed, you must notify the Division of Coastal Management(DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (810) 79&7215. No response is
considered the same as no objec#on if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. Of 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
(Property,.Owner Information)
U/ &=fo
�ifitm e
J-( vv,, VVX t LI
Print or Type Name
(A 'cent Property Owner In ormation)
0 f
Sigrraftwe
f\t'tn 4-Mkk, an& Wi,4A i e_t
Print or Type Atame
Mailing Address
1-7 1-
79Di 224z &k s J17.—
Mailing Address

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