Levert, Rich 77334C

�PdAMA / ❑ DREDGE & FILL N9 77334 A B C D
GENERAL PERMIT Previous permit#
ipyv ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �;��
and the Coastal Resources Commission in an ar a of environmental concern pursuant to 15A NCAC
j ( t
1 � g ules attached.
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Applicant Nae4 1� t ( tz'bf'i'� Project Location: County 1 �
Address
Street Address/ Road/ Lot # s)
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Affected OFA
AEC(s):
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❑ HHF ❑ IH ❑ UBA ❑ N/A
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❑ PWS:
ORW: yes no
PNA yes,/ no
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Agent or Applicant Printed
Si tore Please read compliance statement on back of permit**'
(1( l
Nplication Fee(s) Check #
Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _i'S A� ,n I=f yLf-+
Mailing Address: Q2>Dq 1° 1 A I I c -1 u,...
Phone Number:
Email Address:
I certify that I have authorized
�592-
n2!a _C_ ow
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: D00k_
at my property located at �(D ivy t9 j/Yla f�0�i
in fi'r '- . County. J
l 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 evacuating information related to this
permit application.
Property Owner Information:
No—mm
�� U--2 v-er
Print or Type Name
Title
©......
Date
This certification is valid through da—/ 1 / �c

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: :J� ic,L �tr ` .Q oe, r L _
Address of Property: U Ctvj 10f KJ1 A]
(Lot or Stree) #, Street or Road, City 8 County)
Agent's Name #: ��j 1. Vk
Agent's phone #:
Mailing Address: `C )s --" 6L V—
���k
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
✓' I have no objections to this proposal. I have objections to this proposal.
If you have objections to what Is being proposed, you must notify the Division of Coastal Management
(DCM) In writing within 10 days of receipt of this notice. Contact Information for DCM offices is
available at hD-11w_,W_tccoastalmanapament netlweb/cmtstaff-listing orby calling 1-888.4RCOAST.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(Prope �er In ation)
rJlgnalure /
1,eu�-e(4-
Print or Type Name
Dote
(Riparian Property Owner Information)
691nature
Print or Type Name
G� K
Mailing Addres /' %
6 2 4r
Citylstata0p
CnMM J '3 9 _r . G_ l a
Telephone Number! _("mail Address
dl'Z % 2�
Date
(Revised Aug. 2014)

CERTlFtED MAIL •RETURN RECEIPT REt', UESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: R i r_j�, +
Address of Property:
(Lot or Street #,`utreet or Road, Ci�ity& County)
Agent's Name#:Mailing Address:_
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawinctwith dimensi©ns must be ptovided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact Information for DCM offices Is
avallableathttp;/Iwwwnec asalmana ament.n t/web/cm affiisin orby calling 1-888-4RCOAST.
No ra_snnncA to rnnclAa..../ •A., .._..._ __ __ _..,_ _..
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 trust 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)
Signature
ArintorT�yp`eName
Q- 1 i 019
Date
(Ri ian Property wner Information)
Signature
c GcJ Aile I i�rJ
Print or Type Nam/ e
10 1 ye` iqp Ljwc.
Marling Address
t.1 � �
C(ty/State2i
LOW. M 801-0/?/ a6A1kf)V t rl Doti(
Telephone NumberILMO Address
_,�i.Lo 1�
Date
(Revised Aug. 2014)

U.S.
Postal
Service"'
'CERTIFIED
MAILL" RECEIPT
nompslit Mail Only
For delivery inlo(oudion, visit our vvvbsde, it mvivin4in com
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50.55
12/19/2019
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