57376D - Ritter

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
el F. Easley, Governor Charles S. Jones, Director William G. Ross Jr., Secri
Authorized Agent Consent Agreement
9 n-nyAe it--t cc'C- c ti %c:-is hereby authorized to act on my behalf
(Printed Name of Agent)
!r to obtain any CAMA permit(s) required for the property listed below. The authorization is limited to tl-
c activities described in the attached sketch.
TION OF PROJECT:
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✓ R.
ERTY OWNER MAILING ADDRESS:
)RIZED AGENT MAILING ADDRESS:
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PHONE NO. 9/0 -3a -
PHONE NO. (Y/b - 3- ;> ` 3`J 2S

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Mailing Address
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 7ZX Lz� oj�J M.1-4 L . P—. /kr 's
(Name of Property Owner)
property located at I
(Lot, B1ocli, Road, etc.)
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onS in O�JFL 4O Ld Ca)WJtj 10 N.C.
(Waterbody) 7 (Town and/or ounty
Applicant's phone #: Gl Iy 3111 3'70 I Mailing Address: 7 ( -cir
NL Z,Pj/
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
N I%� KI do wish to waive that setback requirement.
--------------------------------------------------------------=---------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
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ec t S+L-S o r\'e v> ;'Fi 8' to S ko. ('e'
--------------------------------------------------------------------------------------------?--- t -----------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Signature

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C Division of Coastal Ar19t, Habitat Impact Computer Sheet
plieant� �I V/ Permit #:
1
te: �/
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
)itat Name
M
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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Other
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Z�
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