57312D - Ferrante

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee Freer
Governor Director Secre
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
Owner's Mailing Address: Agent's Mailing Address:
Phone Number
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 to install or construct the following (activity):
(my property located) at
This certification is valid thru (date)
Property Owner Signature
Date

ADJACENT RIPARLA.N PROPERTY OW-INTR STATEMENT
(FOR AVP.IER&f00RIXG PII I_VGSIBOAT.LIFTiBOATHOl.'SE)
I hereby certify that I own property adjacent to
(Name of Pro erty Owner
property located at L 6 � _ �cl; ` uLb, �jr,+� 1 '�k i t
(Lot, Block, Road, etc.)
on OLD T`0R --1+tL= to t ois5j�-( L �i e l".5H-0-1 — j�-, ,'t�k ''t N.C.
. (Waterbody) (Town and/or County)
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 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.)
I do not wish to waive
L, 1 do wish to waive that setback requirement.
------------ --------- ------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
If you have •objections to what is being proposed, you must notify the Division of Coastal 'Management (DCK in writin
within to days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at (910)'796-7215_
No response is considered the same as no obiectfon if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
-3og Ol_bt. f
Mailing Address
City/State/Zip
(t7 �i7'
(Riparian Property Owner Information)
Sib ature
Print or Type Name
Telephone Number

ADJACENT RIPARLAUN PROPERTY OWNER STATE''NVINT
(FOR A PIERli�IOO.RIiVG PIL. %GSIBQATLIFTIBOATHOUSE)
I hereby certify that I awn property adjacent to l/i� y q-G 1
(tiame ofProperty Owner)
property Located at �- or 1 —cr,� C7L b� r',� i r g3
l� (Lot, Block, Road, etc.) -
on 0 -FC=P A-tt C in 1 t)i?Sf#f 1_ E Dti`�� ttti j did '�C.t� N.C.
. (Waterbody)
(Town and/or County)
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 understand that a pier/mooring pilings / boatlift / boathouse must be set
back a minimum distance of fifteen feet (I5D 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
I do wish to waive that setback requirement.
- ---------------------------------------------------
DESCRIPTION AND/OR. DRAWING OF PROPOSED DEVELOPAffN-T:
(To befilled <lled in by individualproposing development)
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in writir
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wilmington, NC
DCM representatives can also be contacted at [phone].
No response is considered the same as no obieciion if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
3 c; 9 01->6 ,-,v'r 4o0
Mailing Address
City/State/Zip 0
(Riparian Property Own"formation)
Signature
lC14A52— 02-L
{ Print or Type Name
0 cO n'77(F &2— 91-0 b/z 45.o
Telephone Number
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Tel Number

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TRAVERSE ALONG
NORMAL HIGH WATER LINE
L2 N 28009'47' E
L3 N 2802230' E
L4 N 01°26'10- E
L5 N 00°26'32' W
�KC 4.0, .3 , t7 g3 L76 N 57°24'049'3�" W
N4 'V 1 D2, L8 N 11 °20'56' W
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.� 1.17'
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15 op,/ ' ' �,.,
EDGE
0 s� 8' 4
0, 58'
OF
TIDAL MARSH
/
ELEV. l Tjpq� ►I ZA
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/ 2
1500, v
p� \vv 82.04'
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4.19
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a
NORMAL HIGH
WATER LINE
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9
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C Division of Coastal N19t. Habitat Impact Computer Sheret
)pficant: N tit- Permit #: cj�-3�ZL
ite:.
't h-
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat Name
9 vv
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
temp impacts
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
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DELTA DOCK & BOAT LIFT
PO BOX 3532
TOSAIL BEACH, NC 28445
PAY
THE
OR /%l
ORDER OF / V
® First Citizens G
8293
DATE + ~ 66-30/53I
365
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FOR
1120013293111 l• --- AP
.0531003001.00353 199150411■