Torres, Yvonne 76777C (2)

CAMA / D
ENERAL
e Modificati
EDGE & FILL
PERMIT
on Complete Reissue Partial Reissue
N 01F 76777B
Previous perrnit
Date previous permit issued
As authorized by the State of North Carolina. D-epartrnent of Environmental Quality �
an<j the Coastal Resources Commission Mn are area of environmental concern pursuant to I SA N A __ �
Applicant Name project Location; County
ir
Address _ _ -. 1)_ Street Address) State Road/ Lot # (s)
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Phone �E-Mail Subdivision _
Authorized Agent
Affected EW k PTA
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Printed N arne
PermitOfficer's Printed
S tore "Please read c ors, p ri anc a Statement on back of permit * 0
(V,-w
plicat Fee(s) Check #
Signature
0
ISSu � t�
E x p r2t io date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to f �,, ,J % I �;% nk-� `I, c� n''P S 's
(Name of Property Owner)
property located at J'r' . >�� (l '�; 1 � /:���' , �'� c iV 0 2
(Address, Lot, Block, Rdad, etG.)
r,
on ��� ,� -t in ` , N.C.
( aterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
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)
Dock to be built approximately 100', with 16' x 16' platform at the end of the dock
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
perty weer Information)
�� �.'N I �' /-':� Z' -- —11�- �� 14—
SignNtur�e
/L(I-VIr v /tDw'
Print or Type Nam
L.
l%_ d �r�S
Mpi,ling Address
9 C' 2-15
City/S te/Zip � � 7 ��
Telephone Number,—�;—/ e� , /'.�q _
'2— JD
Date
(Adjacent Property Owner Information)
L. 'Dtte-'S
Print or Tye Name
/, / C/ L 46- e /e r- v_
M ing Addres
City/State.lZip
`76g-S 4-yp7
Telephone Number RECEIVED
Date
JUN 0 5 2020
(Revised 611812012)
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
`(N e oProperty
Owner)
ci property located at f
(Address, Lot, Block, Road,` etc.)
on P in Li 4t'-) .N r , N.C.
( aterbody) (City ownand/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
have no objection to this proposal.
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)
Dock to be built approximately 100', with 16' x 16' platform at the end of the dock
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
0
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
�3.ignaxkur �--.
f 0 v"Z.,
Print or Type Name
`% iv �1 G" G ►�=�
Mailing Address
City/St te2ip
Telephone Number
Date
(Adjacent Property Owner Information)
,Sign,. tune
,cam A o ri-e c%h in o ki P�1,JJ �rcQ
Print or Type Name
Mailing Address
City/Stat /Zip
)
Tele ho e Number
E/ENE®
Dat
(Revised 6/1J, 1®)5 208
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