59281D - Angel

I CAMA / ❑ DREDGE & FILL
MEN E RAL PERMIT Previous permit #
ew LIModification Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources `2
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 1y G
Rules attached.
t Name Ov C Project Location: County -9KU YASLU" � U'L
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distance offshore
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ALT-W;WA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
,erly Eaves Perdue Braxton C. Davis
rernor Director
Dee Freen
Secret
AGENT AUTHORIZATION FORM
Date: 6 - ` - / 1i
e of Property Owner Apply' g for P rmit: Name of Authorized Agent for this roject:
IZ
:r's Mailing Address:
`Uo
L
e Number (A
Agent�atlin Address.,
Phone Number
ify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
id obtaining all CAMA Permits ncessary to install or construct the following (activity):
ny property located at / ,13 C>17B A.] L — /S 2f I k J A-), C-
;ertification is valid thru (date)
Property Owner Signature Date

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/B04 TLIFTIB OA THO USE)
I hereby certify that I own property adjacent to `s
(Name o roperty ner)
property • lamlocated at '
(Lot, Block,
on !&J�D Dfre 64n4J in
(Waterbody)
J
Applicant's phone #: , (10'(0� I '�
1, etc.)
N.C.
(Town and/or County) �—
Mailing Address: nnl� Iwr
/s
z ( )�6
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understan
must be set back a minimum distance of fiftee:
waived by me. (If you wish to waive the sett
"bellow.),
I do not wish to waive S (`7 �-
I do wish to waive that setback regi
------------------------------------------------------ Y
DESCRIPTION AND/OR DRAWL:
(To be filled in by indivi
(Information for Property Owner Applying
for Permit)
-----------------------------------------------------------
(Riparian Property Owner Information)
Mailing Address
v Signature

US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENTJRIPAR[AN PI2QPERJIY.OWNER STATEMENT
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Applicant's phone #:U + —1}Mailing Address: Mp G f—
f�r la�13-i. Y1 , �736
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 of drawing,
with dimensions, must be provided with this letter.
1:�� I have no objections to this proposal. I have 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
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, or lift 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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
jf,Aj�
)�
Signature
V)
-A
Print or Type Name 19
Mailing Address
(Riparian roperty Owner Information)
Signa
2)�l
Print or Type Name
1?0
Mailing Address
�/,v11Tat,, . Yl L
W( y)C- A-?3o I

:)licant: G7, ek Permit #Z� 1
:e:I �/
1 a
;cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
nd in your Habitat code sheet.
itat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tem impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
Z 3
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
1 32�L
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