76570D - Jurney

1.CAMA / � DRODGE & FILL N° 76570 A B
'ENERAL PERMIT Previous permit #
New A Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environmental Quality
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ('�� .,�—O0
❑ Rules attached.
t Name i1 t Q 'H U. \3-1I „li4A C Project Location: County /Q c
Street Address/ State Road/ Lot #(s)
State ZIP 2 10
U-0191 U (t"I S-A E-Mail (awnC Subdivision
edAgent City C--Cep- ZIP Z �
[*CW ❑ EW IN PTA ❑ ES ❑ PTS Phone # ( ) River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
. Adj. Wtr. Body
❑ PWS: A
yes / � PNA yes /� Closest Maj. Wtr. Body A W
Project/ Activity l� a\` &0, i` kp o cl� • t
(Scale: <J
:k) length k f
ttform(s)
Platform(s) x Y (W
er(s)
igth
nber
1/ Riprap length
distance offshore
x distance offshore
cannel
)ic yards
ip
se/ Boatlift { j( (3.1
Aldozing
Length "' U
not sure yes no
cum: n/a yes Ker
Yes .._...-f -—. { _.
L ............_ I .. \ttached: /no
ig permit mayuired by: L¢ ,� t4d c k eic h ElSee note on back regarding River Basin n
Local Plannine lurisdiction)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name ofPfoperty Owner- Requesting Permit: jr, 4-eV 4-
Mailing Address: 3?-I S y� 'f'�mn� ��
Phone Number: 719 e ,3 (7'-4/7
Email Address:
I certify that I have authorized_C�'15�
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 l ! I'�d�B1't s�: Ole�✓I e�Cl-1,
Z
in d5intg'ilcotG4County.
I furthermore certify that / am aulorized 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.
Pro r_yt Owner Inf tion:
Signature
Print or Type Name
Title
zi , Z3 , ZD

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: %i' Q JU(-n-Q:NA _
Address of Property
`� MILA re a
cQGr, -6�0-
(Lot or Street #, Str et or Road, City & County)
Agent's Name
Agent's phone
Mailing Address:U'
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.
_` � ave no objections proposal. _ I have objections to this proposal.
No objections if constructed in accordance with the attached drawing.
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., Wilmington, NC, 28405-3845. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection 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. (If you wish to waive the
setback, you must initial the appropriate blank below.)
!' � /� t✓ I do wish to waive the 15' setback reauir„�� e�m=h
15' setback requirement waived, so long as the setback is at least 10'.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
r'
vi t 4 + 1nru �i 6-
S)
Signature
Wk\\� Jur
Print or Ty Name
I�l 7Wr-g��L Pa��
Mailing Address
ChacIb �k N(- 2'92-I0- 1�`t
r'ity/RtatP/7in
1
j nt Property Owner Information)
Signature
Robert B. Womble
Print or Type Name
609 Blenheim Drive
Mailing Address
Raleigh, NC 27612
Citv/State2ip

Y
CERTIFIED MAIL . RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner:�'��yU�n
Address of Property: C� M60 r- &-
(Lot or Street #, StrE
V .
Agent's Name #: ` r ICE nS�('UCrTIv
Agent's phone#:Cl\w`, �- �-quas
or Road, City & County)
_ 6L" I U ���ti�
� Mailing Address:
�\��� S&6N� Z-6y(q
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.
— Tr�no of ectiions oar-5ro'posefy i have objections to this proposal.
tf 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., Wilmington, NC, 28405-3845. DCM representatives can also be
contacted at [phone]. No response is considered the same as no objection 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. (If you wish to waive the
setback, you must initial the appropriate blank below.)
I do not wish to waive the 15' setback requirement.
(Property OwnerInformation)
, ice] l };A'u ( Ctge,1�)
.Signature `
Print or Ty Name
-311-\ yar-\� C
Mailing Address
, Ab k � � Z�ZL U -(�q
City/State/Zi,a
(Adjacent Property Owner information)
) Ov u W-I t G U cz v1
Print or Type Naffle
c seek } ►,.
Ma ing Address
V-a (2, � eve ..Ak J ' !)3
City Stata/7in

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04/21/2020
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