77871D - Ocean

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date /p11/5/?-2
Name of Property Owner Applying for Permit:
0911..--. h le_ N {Pup
Mailing Address:
7 Ki"r/n4& o /4-i)
I certify that I have authorized (agent) Avp 1iI / fJ po to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) r1 j2 -ff 2, / L4--9&('I(
at(my property located at) /0_J oz+e4,.,_ 1 5 /e L l�s t 1 L1 •
This certification is valid thru (date) ! f AS/a •
1PILODD
Property Owner Signature Date
1

2Cia. (1•(7X&0 tl"Wt,U "*
0 _1 CAMA/ ❑DREDGE & FILL N9 77871 A B C Cb�
GENERAL PERMIT Previous permit# l
)C New Modification _ Complete Reissue ❑Partial Reissue Date previous permit issued 1
As authorized by the State of North Carolina,Department of Environmental Quality /�
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC C 4 SCDC:)
❑Rules attached.
Applicant Name [Qr,,,1 (S;.t cS(M c„4 (}. LC `1G Project Location: County L-Cwi w, c_k___ •
Address 4-1- 1. k-1,n AA r wn 2 a Street Address/State Road/Lot#(s) /t.! Vim^
CityL.)./x S kbn S ..j e State ►‘JC ZIP 2_1.-1 cIS I /t L..)e S t ►J/vc-I
Phone#( ) "'—` E-Mail �' Subdivision
Authorized Agent .A(L 7 & City ��-�- (:J t- dam.c-L1 ZIP Z� i Ln`�
Affected CW EW PTA ❑ES ❑PTS Phone# (710)`- t) Z I ci t River Basin C.,/ ✓
OEA HHF ❑IH ❑UBA ❑N/A AEC(s): Adj.Wtr. Body J,-,.i,__ fc.,_C . L. �ia nan /unkn)
❑ PWS:
ORW: yes IC per' PNA yes no Closest Maj.Wtr. Body AA-L``� Oo-¢-G-'N
Type of Project/Activity K--1-ti✓•j c A O c L...,.1` cc c %(%1•11 k 1 .S c )C e�,.‘ F G L.,,411
, .. ,�-.��5,(..1 S a� ei-,_ Sj a f M (Scale: N T S )
Pier(dock)length
Fixed Platform(s) /G.1X( Z ` t ' ; i I •
Floating Platform(s) 0 ! X i C,r s ,_ r ' 1 t(-c LA —
Finger pier(s)
Groin length — '
number — I-
Bulkhead/Riprap length
avg distance offshore ' W.
i"- .
max distance offshore I i Iq
I 1
Basin,channel I•
cubic yards ' t
Boat ramp fi 4
-' r
Boathouse/Boatlift i" ! �•,- . 1
I �_- 1
Beach Bulldozing ��..F0_L-� w
Other flip�teTehiew- ..- _.�„ +� apt ill, /11 l c.
I
i ii
Shoreline Length 5 Z.:!)f { -t ` .: ktIs {
SAV: not sure yes no i I I i
Moratorium: n/a yes drill ` 1S14
Photos: yes _ : j.._._.... _f..1'�' (.+C _.. w c i
Waiver Attached: yes ( , (...
// '
A building permit may be'required by: -'1 1 �'�' Q ca.. 1 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) -\
Notes/Special Conditions . ) .,)Qt (C ,^ r,c I i L.,..) � 0 "0 f 911CC¢..Lc �t.e i ( c, �+ ( ,i c
clap( f a (
1 ,-,, ,/ /SJ ti �/e ---.c1y-\ \ '0c1-
Agent or Applicant Printed Name Pernii ted Nam� __,,,__
i .?,
it--
Signature Please read compliance statement on back of permit** Signature .f 5Z62
r
Application Fee(s) Check# Issuing Da e Expiration Date