Ramsey Development Limited Partnership 78202C

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Name of H'operty Owner Requesting Permit:{,
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Mailing Address:
Phone Numben
Email Address:
I certifu that I have authorized
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Ageni lractor ,Aqr /e/,J @5,t<i'' <rs ,'r
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
neeessary for the following proposed development:<( €X.
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l_t1tfierm9r9 certify that ! am authoized to grant, and do in fact grant permission to
Divis.ion o-f coastal Management staff, the Loial permit offrcer and iheir a'gents to enteron the aforementioned lands in connection with evatuating information -ielated to thispermit application.
Property Owner lnformation: -- -.
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Signatu
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Pint or Type Name
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Date
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
at my property located at
Title
RECETVED
sEP 18 20?0
DCM.MHDCIW
This certification is valid through -1:_lZl_:a !__
ADJACENT RTPARIAN PROPERTY OWNER STATFMENT
I hereby certify that I own property adjacent to R ,rl
(Name of ProPertY Owner)
property located at
(Address, Lot,Road,etc.
in N.C
on
(Cityffown ind/or CountY)(Waterbody)
The applicant has described to me, as shown below, the development proposed at the above
location
I have no objection to this proposal
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndividual proposing development must fill in below or attach a site drawing)
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t understand-ihat
back a minirnum
wish to waive the
a prer
distan
wAlvER SECTION -.-----.'-: ' - ''
,dock,moorin@,boathouse,lift,orgroinmustbeset
ce of 15' from my area of riparian access unless waived by me' (lf you
ck, you rnust initial the appropriate blank below )
z I do wish to waive the 15' setback requirement'
I do not wish to waive the 15' setback requirement'
(Adjacent Pro
Signature
Print or Type Name Print or
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Mailing Address Address
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CiU/StateEip
Owner lnforrnation)
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Telephone Number
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o er
sEP 1 8 2020
DCM.MHD CITY
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Date
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(Revised 6h8/2012)
(Property Owner I nformation )
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Eric Eilis
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205 Nottingham Lane
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Morehead City, NC 28557
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