Watt, Brian 78912C

NCAMA/trDREDGE&FILL
lNew lModification ncomplete Reissu e APyi,/-Jssue
As autho.ized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmenal concern pu rsuant to l5A NCAC
Applicant Name Project Location: County
Address Street Add State Lot #(s)
Ciq/State ztP
Phone #E.M Subd
Authorized Agent
N9 78912
Previous permit #
Date previ
zlP
B
issued
c
City
Afiected lcrw
AEC(s): troEA
" ! PYVS:
trEW
tr HHF
Htsftu*tr PTS
tr N/A
enone#S)
ORW: yes /
A
ItH
PNA yes /
Adi. Wtr. Body
Closest Maj. Wtr. Body
man nkn
]_.H
I+
E
Type of ProiecV ActMty
(Scale
Pier (dock) length
Fixed Platform(s)
FIoatin8 Pladorm(s)--t-l-rlrl L f rll
Fin8er pier(s
Groin length +-L
ivg distance offshore
max distance of{shore
Basin, channel
cubic f.rds
Boat rernp
Boatholsey' Eoatiift
B€ech Bulldozint
Other
Shoreline Lmgth
SAV: not sune
Moratorium: nla yes
,p
A building permit may be required by:Easin rules,note
Atent or Applicant Printed Narne
permit *
Fe€(s)
compliancestatement on back of
Check #lssuing Date Expiration Date
ENERAL PERMIT
Basin
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( Note Local Planningjurisdiction)
back
Signature
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Name of Property Owner Requesting Permit:B,,c \Crfl \,
Phone Number:
Email Address:
I certify that I have authorized
\s \!cs.\s \1 o\ \.u
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Agent / Contractor
l^f!fr:lr?r: certify-that t am authorized to grant, and do in fact grant permission toutvts.ion of coastal Management staff, the Local permit officer and {heir a'gents to enteron the aforementioned lands in connection with evaluating information ietated to thispermit application.
Property Owner lnformation:
t5? J.- =-e+:-
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: s <\q:.s.r$>sA\. os,.
at my property located at \ox L*v\S \r.\. fS.^.,\"\, u..u
tn County.
Signature
c\ o^-
Pint or Type Name
O rrrl..,< --./RECEIVED
FEB 12 ZAZI
DCM.MHD CITY
Title
l2 to z
ateD
This certification is valid through ---/__/_
Mailing Address:
AGENT AUTHORIZATION FOIR CAMA PERMIT APPLICATION
Te.rin
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I hqreby certify that I own property adjace nttd,\Ss S
(Name of ProPefi Owner)
localed at )s's hrcproperty
Address, Lot, B lock, Roain$\r , N.C.on
Waterbody)(City/Town and/or Count$
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal
Ihave -objections to this proposaL
DESCRIPTION AND/OR DRAWING
(lndividual proposing development must fill in
Tr\\. Re$^.r- \..\.1".r "51')N
\r**"4.\(rs'r,w
OF PROPOSED DEVELOPMENT
description below or attach a site drawing)
iNq\ N\ r".,q\"."*
RECEIVED
\\"\$FEB 12 2020
DCM.MHDCITY
WAIVER SECTION
I understand that a pier, dock, moorrng pilings, breakwater, boathouse, lrft, or groin must be set
back a minimum distance of 15'from my area of riparian access unless waived by me. (lf you
wish to waive the setback, you must initial the appropriate blank below.)
N I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement
(Property Owner lnformation (Adjacent Property Owner lnformation)
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s,
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Signaturq . \!_
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City/State/Zip .-1r?.50
Telephone Numbert9- 3^ \at
'snature
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Pint or TvDe NameaOt uc^-,i =QA
Pint er Type Name r,&cr\ i \^rA KJ)
Mail,no Address n \'" \<L;;..-b tr/c )ggtb Mailino AddressHiu(-o€)- IA e((l t-C-
City/Sta
3
Teleohone Number'\z-'3
t - l'l
Date
(Revised 6/18f2U 2)
Yeo..o1
ApJACENT RIPARIAN PRqqERW OWNER STATEIUENT
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\A[ADJACENT RIPARIAN PROPERTY OWNE R STATE]IiIENT
I hereby certify that I own property adjaco:rt t.LSGs\r^\
Name oTP,ope y Owner)
property located at \t r=\\ S \r.t -
on \,,\^\\*'
(Address, Lot Bloc Road, etc.)
,tn , N.C
(Waterbody)(City/Town and/or ou
TRe applicant has described to me, as shown below, the development proposed at the above
K I have no objection to this proposar.
I have objections to this proposal.
DESGRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividual proposing development must filt in description below or attach a site drawing)
)n$. R{..- g.\-0"5\.\\ o\\\"\\ s\\\\\a.*-.
\x\\u"5.\ s*'\-'
\\\-i. B"\\RECEIVED
FEB 12 2020
DGM.MHDCITY
muit be setI und
back
WAIVER SEC TION
erstand that a pier, dock, mooring pilings, breakwater, boathouse, lift,or grorn
a minimum distance of 15'from my area of riparian access unless waived b y me. (lf you
ish atve, 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 requrrement.
(Property Owner lnformation)(Ad pe ner lnformationPro
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gna(-ure \C-\*-\sBir L.'r;tFqr\sl
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Print or Type Name P
Maili ddress
Cty/State/Zip a
Telephone Number
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y:€!ry)'2W
A
\
Date
"1
6
v,e ltzo
(Revised 6/1A2U 2)
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