Azzarano, Kathleen

ME
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LAMA / 0 DREDGE A FILL N9 78970 A e O D
G NERAL PERMIT �
ew ❑Modification ❑Complete Reissue OPartial Reissue Date preikxs pem* issued
As authorized by the State of North Carolina. Department of Envirorenenai Quaky
and the Coastal Resources Commission in an area of environmental concern pursuant to 1 SA NCAC
ursci+ed-
Applicant Nart� Location: inn'
Address_ Stream Address/ State Road/ Lot #(s)'GOL41AA—Q ---
City State At VP�
Phone # 4w) r--Mall
Authorized Agent
Affected `i Cry AJ"A O ES OPTS
AEC(s):
J OEA ❑ HHF ❑ IH O USA ❑ N/A
I PwS:
ORW: yes / pd� PNA A/no
Type of Project/ Activity
Pier (dock) length _--
Fixed Piadwn(s) .r
Floating PW.,n(s)
Finger pler(s) K
Gran length
number
Bulkhead/ Npr+P length
avg distance offshore
max distance offshore
Basin, chuvW _
cubic yards ..� �.
Boat ramp
Boa d- x
Beach fdoZing r
Other .i
Shoreline UwVth -
SAV: not sure yes no ..
Moratorium: tJa yes no
Photos: yes no
waiver Attached: yes
A building permit may be required by:
( Note Local Platu►ing jurisdiction)
Notes/ Special Conditions

AGENT AUTH0 TI0N FQR CANiA PFRINIT_ PPLLICA ION
Name of Property Owner Requesting Permit: %ezai,vy
Mailing address:
Phone number:
Entail Address:
61 r . tvP_ `r c, t.
I certify that I have authorized /t! p jZF lVex'1j,
Agent 1 Contractor
Goy
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: A) ` 6e &'4r
nf77 ;< L-7'
at my property located at/S'
in Oiv.56op J County.
I furthermore certify that 1 am authorized 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_
Property Owner Information:
Signatu
Print or Type Name
Tine
Date �..�
This certification is valid through l > l 76 e'
f f"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to KADJtG&,AJ f�'z A�,�Ntr s
{Name of Property Owner)
property located at / �� Vf��M1� L �N(
(Address, Lot, Block, Road, etc.)
on in SNi='/7Ds't=l N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
NopEn Aet'L r>
WAIVER SECTION
'&'ai- I-,,-,r
I understand that a pier, dock, mooring pilings, boat ramp, 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjapent Pr Owner Information)
AV9' �G r Signature
Fnnl or Type Name Print or Type Name
!/S VO-IVn 60AIF //3 G�FGryso
Marling Address LMve
5i„1W fir. Marling Address
8`�6 a�vFnDS (.f$r AC Gb'�
Crty/State/Lp City/State2'fp 0.- 5�e?- S7S`e ��i
Telephone Number / entail address
Telephone Nu ber/email address
i 1,7
7
)Zi 2�,t
Date -
'Valid for one calendar year after signature" (Revised Aug. 2014)

ki 1t t44 #�t i gggg
{ iti
ADJACENT iP PROPS ER STA'f E 1_'
I hereby cerfify that 1 own property adjacent to &gTNLLLJ A-ZZ49A1v0 's
(Name of Property Owner)
property located at / (� 1/t'Gl�� LANE
(Address, Lot, Block, Road, etc.)
on , in SNt-OD5 fM . N.C.
(Waterbody) (City!%wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
l�1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT .
r)ndiWdual proposing development must fill In description below or aitwh a site draw1n1W
6xfg -wit,
-vt7cx
.-t r- -
(jl) yILnVo -go,,;- L/�!
7`
Eq;P 6 46K "i rt SMOpe-D '6QDCNI>
WAIYR.��4N Soar' cu�7"
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16 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 IV setback requirement.
I do not wish to waive the 16 setback requirement.
(Property Owner Information) (Adjacent Property Owner information)
Signature r Signature*
�0' l�lGlz`r� A �gANa Air',Yva ;ors
P»nt or Type Name Punt or Type Name
//S rcl Mn GoN� 0118-
Meft Address Maft Address
�vg;of &96" Nc �N68 F',orflt �cGC N�--283a5/
c>ty/sYate�p �, Cit,►/stetemp
Fio - S-47— S�s'f' A,e J
Telephone Number/email address Telephone Number/ email address
Date Date#l�#3—