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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: \k-4
Mailing Address: �3al C c 3 JtRALk
C\(\caL N L 2552 )
Phone Number: —1 C]L1 4 U CL —y U Z
Email Address:
I certify that I have authorized
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: \ctLi
s ��•� Clu
at my property located at rl\\ C ci c \ D S\ ,rN, - a 4Lr
in 73c\-korow‘t--\L County.
I furthermore certify that I 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:
.‘ rf4/./y
Signature
1r'iz- V'� r
Print or Type Name
Title
Date
3J�
This certification is valid through '9`\?`e- �-

//-/9
L�CAMA I ❑DREDGE & FILL N� 76523 A B c
GENERAL PERMIT Previous permit# to?MP
New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 2//w/r4--
/f1"1r'"1
As authorized by the State of North Carolina,Department of Environmental Quality .2 Sj.n
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ( ' � J •
❑Rules attached.
Applicant Name ri de. Project Location: County (.�ie w kc\-k
Address 1,'2'4-- (1-t+ L\\ NV,- Street Address/State Road/Lot#(s) 1-1-\`
City C‘f\o-r (.) - State NC-ZIP 2 sL 04- \ \J
Phone# ) (90C9 £i 102 E_Mail Subdivision
Authorized Agent W �� v✓.CE, City ce,-S-e Qt e"-N\ ZIP Z S'-\(D6
Affected CW rtEW .PTA ❑ES ❑PTS Phone# ( ) River Basin
0 OEA -❑HHF 0 IH 0 UBA ❑N/A
AEC(s): Adj.Wtr. Body'
ID PWS. C na /man /unkn)
. PNA yes / Closest Maj.Wtr. Body A'^k S C✓� `1
ORW: yes /(n
Type of Project/Activity IC.�b.i c Q c�\• _ '^ Se }r r•
4- c..-1('h
,SG. .,....„%MN a S pf-c_.- S ib(.,A (Scale: /`.) T S )
Pier(dock)length ' X SC,' \
() j ''d1s� �� , ,.,� Y � � .,�;,1 '_�....
Fixed Platforms
Floating Platform(s) IL, Y iltt N
I II t 1 I -
Finger pier(s)
Groin length ! ( - -, - }
I I
number ..............L...._.._- — -...
Bulkhead/Riprap length --- +2t avg distance offshore . 1
max distance offshore '
i
Basin,channel
cubic yards - ,
1 - M '6S1
Boat ramp
I
Boathouse/Boatlift 4 j —._._......._._ —_-_.._
I I -
Beach Bulldozing I
Other ,
( I e,"L W,iti 414 -1N1 11.
Shoreline Length rJv' D'O 1 ! \ \\ik ON \Z P t"`Jr 1
10
SAV: not sure yes no "T 'f I i 1 4 k i i i' �,
Moratorium: n/a yes 4119 ( I _
Photos: yes 014 ; L (-. —._._..._-- I —._._._.__.
Waiver Attached: yes n• ! I
A building permit may be required by: S...)nStY C3 e,o.0 k . I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) ,�
Notes/Special Conditions Q ��(c t ,`.-� C"r c t``• irt (W%k V t'► rr't, (1.+1•^
(ceD
ia
k\(\C f �;c i 0 C --• AG-. \---310C (C.
Agent or Applicant Printed Name Permit0 icer' Printed Name \/
... t....---q r ..../
Signature **Please read compliance statement on back of permit** Signature
i-- ', tit 111 1 CA ('2.0V4O €,( S I 202,I
Application Fee(s) Check# Issuing Date Expiration Date