59186D - Clifford

CAMA / DREDGE & FILL 5�
iENERAL PERMIT Previous permit#
New . JModification .Complete Reissue El Partial Reissue Date previous permit issued n
zed 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 ( �7 / 4 ' 1 Z0d
❑ Rules attached.
Name CoFrngl> Project Location: County_
o t! .
Q Street Address/ State Road/ Lot #(s)
ML State t4C, ZIP 2,75 (-7
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!d Agent Al E 5-
CW EW �S;H'TA ES r! PTS
C OEA HHF IH ❑ UBA l N/A
❑ PWS: ❑ FQ
Dno PNA yes no Crit.Hab. yes no
t
Project/ Activity LAA
lock)IEngth_
-m(s) I Z IxL
pier(s)
length
camber
:ad/ Riprap length
vg distance offshore
nax distance offshore
channel
ubic yards_
amp
case/ Boatlift
Bulldozing
ne Lengtly,"„
not sure yes
gs: not sure yes
)rium: n/a yes
yes
Attached: yer.
ling permit may be n
C. Aa i f-.A.+;..n
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Subdivision
City � ZIP
Phone # River BasiIV
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Adj. Wtr. Body-6:�*
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Closest Maj. Wtr. Body L L
(Scale: l ��

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Director
,overnor
Dee Freem�
Secreta
AGENT AUTHORIZATION FORM
Date: &--,-- I2
lame of Property owner Applyinq for Permit: Name of Authorized gent for this project:
Dwner's Mailing Address:
Cis}
Phone Number (qIq) cpq-z7-,06
Agent's Mailing Address:
u15-2z NJ.
2 OS
Phone Number
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary'' \J
to install or -construct the// following (activity):
��%J
vB T "I
(my property located) at F Z-
This certification is valid thru (date)
Z-2�-zolZ
A)C- o46
Property owner Si ture
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSB f I C �TLFTBC �Ii USF� n
��JJ (M ���Lf',
I hereby certify that I own property adjacent to
(Name o Xroperty Owner)
?roperty located at 2
-,in
lSTeAzA , N.C.
(Waterbody) (Town and/or County)
EIe has described to me, as shown below, the development he is proposing at that location, and, I have
ao objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
back a minimum distance of fifteen feet (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.)
c/ I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
------------------------------------
(Information for Property Owner/Applicant
Applying for permit)
IGI� e-L i �PKVOi
Mailing Address
City/State/Zip
RECEIVED
DCM WILMINGTON, NC
MAR 2 6 2012
(Riparian Property Owner Information)
Signa +re
. S fi-�_ L v `
Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to\) I �C—�1'� is
(Name of Property Owner)
)roperty located at
(Lot, Block, Road,
)n �,i' L✓1 , in
(Waterbody)
own and/or County)
N.C.
Je has described to me, as shown below, the development he is proposing at that location, and, I have
io objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse must be set
)ack a minimum distance of fifteen feet (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.)
do not wish to waive
1 do wish to waive that setback requirement.
-------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
V � l
RECEIVED
DCM WILMINGTON, NC
MAR 2 6 2012
--------------------------------- -----------------------------------------------
(Info mation for Property Owner/Applicant (Riparian Property Owner Information)
`i Applying for permit)
Si
Mailing Address tur
&�AK�0 K�C,
City/State/Zip Print or Type Name (�
_i .. n AAAII nip ���

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