McCoy, Vincent 78832C

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AMA / ❑ DREDGE & FILL�c73L A B D
NERAL PERMIT Previous permit #
w ❑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 area ofenvironmental concern pursuant to 15A NCAC
ules a ti ched.
Applicant Name Project Location: County
AddressVi-e-JAIStreet Address/ State Road/ Lot #(s)
�7� State zip
04
Phone#(�) —a ! E-Mail Subdivision
Authorized Agent Lyr. City ZIP
Affected ❑ CW 1A ❑ES ❑PT5 Phone # ( ) River Basin
AEC(s): J OEA ❑ HF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body. (nat / /un
❑ Pws:
ORW: yes /:no ' PNA yes o Closest Maj. Wtr. Body
Type of Project/ Activity OOSA,S t
Pier (dock) length X
Fixed Platform(s) _J
Floating Platform(s) v7 , f
Finger pier(s)
Groin length
number --
Bulkhead/ Riprap length
avg distance offshore
max distance offshore s/
Basin, channel
I�
cubic yards
Boat ramp
Boathous Boatli 13
Beach Bulldozing_
Other f
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
��
(Scale: ! 1 i
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LAT
—7-
1
r\d
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J
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f
— —
—-I
3
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Waiver Attached: yes V nqr --
A building permit may be required by: tlae,
( Note Local Planning jurisdiction) . A t
Special
❑ See note on back regarding River Basin rules.
MIP
Permit Officer's Printed Name
Signat re
. 6
Iss� ng to ✓ xpirati, n Date

AMA / ❑ DREDGE & FILL `✓u N9 78832 A B 0 D
GENERAL PERMIT Previous permit#
w ❑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 area of environmental concern pursuant to 15A NCAC ©:6,1,r
l� ales a ched.
Applicant Name Uj n ft;ij /I � — 0 V/ Project Location: County C '�
Address I V � . W E-w , _QkJ L Street Address/ State Road/ Lot #(s) 107 Elm &-t
Phone # (W)791— 03/2 E-Mail
Authorized Agent 2— C bo�
Affected LiGW � jy J)fTA ❑ ES ❑ PTS
Affecte ❑OEA ❑ HF ❑IH ❑UBA El
❑ PWS:
ORW: yes / no PNA yes
Type of Project/ Activity
Pier (dock) length /p %' �Gy
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length 1
number��
Bulkhead/ Piprap length
avg distance offshore
max distance offshore
Basin, channel
_
-
_
—,
-- Q 7 ra 5
cubic yards '�
Boat rampBoaCli J 22 ryry
Boathous x 7
Beach Bulldozing I
Other S 1
_1 I
Shoreline Length
SAV: not sure yes Cn
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notgs/ Special Conditions
Sr,4
ke or Applican Printed Name
Si nature "Please read compliance statement on back of permit"
Abplication Fee(s) Check #
Phone# ()
Adj. Wtr. Body
Closest Maj. Wtr. Body
0
1/ f
(Scale:) i�
❑ See note on back regarding River Basin rules.
�eLiS* 0 '��Od"l
Permit Officer's Printed Name
Signat re
yl ,2l
Iss ng to xpirati nDate

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1/ i Vlcen ` /11 cc0x/
Mailing Address: I77 wrik Vim G,l—
Uj ayregton 0 a.. 0
Phone Number: 70 3 — gP9- 0 1)
Email Address: V yV) ceoy tp Qrt S� t ��, C0 ►v�
I certify that I have authorized 1�x1 u�yi�
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: VIW\3 1 LOi � U) yA(
_�1�i� YX'X mil UF7 ,9-0\ OG Ur1
at my property located at V)j -LL1-A (T. OL\W0ULc,\A( :
in (D?F2LA County.
l 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:
��GnaZ'Pja 1-.)7 ye:v
Signature
I it hcent McCort
Print or Type Name
Title
I I 130 / 0,0
Date
This certification is valid through �'L_I ',�_)1 I '%
pj4Roo
C�, 3LHy
RECEIVED
JAN 14 2021
DCM-MHD CITY

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: V lA. U-1 "( (-LN
Address of Property: 10-1 -W-A L . I l)W.S , W OU-S)ACOn
(Lot or Street #, Street or Road, City & 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 drawing, with dimensions, must be provided with this letter.
J I have no objections to this proposal. I have objections to this proposal.
I 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
2 available at htto:Uwww.nccoastaimananement.neNwebVemlstaff-Iistinporby callingl-888-4RCOAST.
No response Is considered the some as no objection if you have been notified by Certified Mail.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
i 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.)
a I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) Ri arian perty wrier Information)
Signature Yignature
Print or Type Name Print or Type Name
t-11-iiSCM 302s'Soupwo✓n k,
Mailing Address Mailing Address
UJE�� y.4 ,SIR ol� (J2c�s.>sguta, ,,Ale- 2�YO F
CitylStatelZlp CitylStatalZip
(i0'�)q<P-0Md U V -.29?,3G3f1e-444'.w
Telephone Numb
1er/E�maiill Address Telephone Number Email Address
Date Z I �Yi ` Lll (�� Date /
(Revised Aug. 2014)

I
■'60W a?e Oms 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
II I'III'I I'll ICI I III ll ll ll� I I I� II II IIII Illl III
9590 9402 5576 9274 8755 51
J19 0160 0000 1777 2431
PS Form 3811, July 2015 PSN 7530-02-000.9053
X
❑ Agent
C. Date of
D. Is delivery address different from item 17 'U ve
If YES, enter delivery address below: o
3. Service Type
❑ No* Mali Express®
❑ Adult Signature
❑ Adult Signature Restricted Delivery
❑ Registered Mail"
❑ Registered Mail Restricted
[I Certified Mail®
❑ Certified Mall Residcted Delivery
Delivery
❑ Return Reoelptfor
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
Merchandise
D Signature Confirmation^"
❑Signature Confrmation
1I Insured Mail
I nsured Mail Restricted Delivery
Restricted Delivery
Domestic Return Receipt