Daugherty, William 79531C

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aEMA / `DREDGE & FILL
._J
NERAL PERMIT
N 79531 A B C D
Previous permit
�Aew
DModification 1 t - - -rtil iu Date previous perry i t issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the coastal Kes u r e %_..ammiss n in aft gyred of ! I V"i I leltU WMAJ I" [JUI Utll I L t
Applicant Name
Project Location: County
.- -7 Rule attached.
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Address_ _ 4 � L, f Cam: n _..._.._ ...__...__... Streit Address/ State Road Lot #(s)
City ����' �4?00--t State�� ZIP
Subdivision
. �_.Phone r. _ �. i T
ti
Authorized Agent 1-W D PTS Phone #
- - -- -
Affected 5_i� r- -
AEC(s): OEA L, HH. F I H L] UBA 0 NIA Adj. Wtr. Body---
P 7
. 4sh
Closest Mal. Wtr. Body
1 n VType of Project/ Activ ity
ZIP
4Ever Bas n
r ne �.1man lunk� pet
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J (Scal
Pier(dock) lint � � ,�.,.. _ ...v... �-��-T'.. Y...._�..v�.�...�_�rT.._ .._ ..._....__.��vys........ .sr,.r,,.�, . _.. • .w, .., -- '�.-r'..�--�' � . - .---�--�• . ....... + _� R_ . ... ... .�_
.ram.Fixed Platform(s)
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Floating Piat.form( - = y
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Groin leng
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avg distance offshore
max distance offshore _#j i. , 1 -+�---,..� r_.�r r ..r _
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Boathouse/, Boat#ifs
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Beach Bulldozing
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Shoreline Length
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a ratoriuni; I� fires 0
F
Ph otost yes - a
Waiver Attached: yes �O
building it maybe required - See note on back regarding Riven Basin rules,
Note Local Planning Jurisdiction) �
}
Notes/ Spe6al Conditions �}
ftent o.AOf]iiCant Printed hlar
Sig
A plieatian Fee(s)
U
ccm}xlrance statement o hack of permit "
Check #
4,
PermitOfficer'.
cer'.
Signature
Issuing Da�
.- �- - --- --- - --.ExP i ationD to
i

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: )g �, ��� �, i1 ell -C
Mailing Address:
Phone Number: S 4 14 1 5 5 9
Email Address: flaWre.,Ce oy&p (Z) Y&"il' Q-,-
I certify that I have authorized
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: A- C1 C, 'Doc. K
�R OCJ i . I
at my property located at L!S 9 KS'/
in �ierz County.
1 furthermore certify that l 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:
I—SigYature
Print or Type Name
o tJ 0 6r
Title
Date
This certification is valid through � Z' / '3 ( ! Z ( RECEIVED
MAR 24 2021
IDCM-MHD CITY

Wil W41, T"HIN= allv0%, onus-
i4mInt-03

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to k f wdt r ZA4-1-9 h I 4_'s
(Name of Property Owner)
property located at 124 C Iar4 K"e
/1
(Address, Lot, Bloc , Ro d
on o.r S Cr%ce. � in. .,. ' d-
(Waterbody) (City/T wn and/or County)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
IPS I have no objection to this proposal.
_ 1hame_objeo-ti0rts_to_this_pr-oposal__.____
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
proposing development must fill in description below or attach a sit drawing)
y� o (TA03 o^c
Y er aie1
I^ ,�4
p i3 t
P�o
13'
I SeY s, ,
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. vr-, mist initial the appropriate blank below.)
I do wish to waive the 15' setback requirernent.
I do not wish to waive the 15' setback requirement. /Y�{ % e�t{p 9 v 3 �5-/ 'z—
(Property Owner Information) (Adjacent Property 0 ner Information)
kT r _ &-I o �?
City/State2ip
,IY;,-4 J-ZRctq
Telephone Number
3-
Date
or
1
-' ' ' ' ' I ' "" ` RECEIVED
Telephone Number
3-1�-mot
Date MAR 2 4 2021
(Revised s/tfeM?A H D CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to 41 A v►t 4 n Br1Tv s
r (NameofProper Owner)
property located at
{E4ddress, LOt, IOCK OR®,
on Al'r? �r1, in. r , N.C.
(Waterbocly) ityl own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
4 1 have no objection to this proposal.
awe QJ) -ions to_this_pr_oposal__._____
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proporg development must fill in description below or attach 6 site drawing)
5��a �,4
r 13 &,aos a eE
Orglaose�
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.
IUD I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
I SA&% �% ., - J18u t,�_
Signat e f °� I Signature /
1,{f��1,aM Y �sYNaK /. I.Am-ire,,, 1J• DaeLtrSO-J
Print or TyPP� Nary10 ���— Print or Type Name
2 Et G C%�¢r K Ld ?0
Mx Ad res� N 6 2Fla�(G MaiC g Addre NG 2 br
City/State2ip, , _ _ Ciy/State2ip
Date
Telephone Number RECEIVED
Date MAR 2 4 2021
(Revised s/1sNIM_MHD CITY

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