Stevens, Richard & Beth 80404C

Emailing: Image (179).jpg
®JAMA / DREDGE i FILL N9 80404 A B
ENE L PERMIT Prrwlous permit #
ew �OModification L]Complete Relssee�Partlal Reissue Date previous %permit issued
As authd by the State of North Carolina, Department of Environmental Quality
and the Coastal flekmaCom2minrar4on�or concern pursuant ro I SA NCAC
, es azU
Applicant Name J roject Location: County--_Q_�
Add _ Street to d/ Lot #(s)_- _.
Add Street
ZIP_
Or
Phone #'DW- [ F4 777U Ae& I Subdivisl ' _ ;
Authorized Agent `1� f _ _ City Q,ZIP
Affected �CW -rv�A r4l i Phone#�j=Nver in
❑DEA OHHP JiIH ❑UBA A li( net u
AEC(s): Ad). Ww. B
PWe:
�M,� J Closest Maj. WtF. BodyT n
ORW: no PNA yes I (-r /p
Type of Project/ Activity LbaA 44
Pier (dock)langth �—.
Fhed Platform(s)
Fbatlng Phderm(a)
Finger
Groin length
number - 1
&Ikhead/ Wprap Im:gdl
avg dmo ce offshore //(,/ _ ) �r♦ �fj �t'/' distance oRs-ye'--�iI
cubic yards
r
Beath BulMozing-
Od1M
t
sler¢Iirre tanglh
SAV: not aura yes is ;. _...._
Fbntorlum: Na Y. :_ _ _. _. _ �_.. _. _ _ _. _.I .. _ _ __. _-•_ . __ _ _._ _.
Wrier Attached: yaa -- --- -. ..- ----- '..--- -
I
A building permit may be required by: U See note on back regarding Riv/er Basin rules.
( Note Lod Planninglurisdictlon) .. , . _ _ aA'.
Signature To
2 of 3 5/24/2021,11:05 AM

I hereby certify that I own property adjacent to XACW-0 S7�-'UC°'-' S
property located at �-3 n o-&1- CA z-C—'< ()/L (Name of Property Owner)
(Address,
on 7l t�2 C2't�C , In.
(Waterbody)
i
appli nt h s described to me, as shown below, the development proposed at the a
tic
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Ind/vldue/ proposing development must flll /n description below or attach a site d►ak
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or
must be set back a minimum distance of 15' from my area of riparian access unless waivr
me. (If yoto waive the setback, you must initial the appropriate blank below.)
6'1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro"or Information)_ (Adjacent Property Owner Infermatle
Y
Telephone N m r/ email address
Dar^ e
(Revised Auo. S

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 97-e V&N S
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Ir2-- Yzz-ZY,s 3-
Jr3 3 t7-eefC, ✓'
n.!Itt10K r
jobrl l tDlQn y00l)l rmsof pr%rAla
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Mr4y/-)T&,-jANcc- ID fLe vJtns oI::-- i3cA-r 13,4sl4
at my property located at Q-. i'J i, 9-P - CAS- ice
in CAJZrZUT County.
I furthermore certify that / 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:
Signature
Print or Type Name
Title
> I
Date
This certification is valid through 0 / / t I -Z-0 L(

I hereby certify that I own property adjacent to (LIC bLMI^ -f J Gam✓ J 's
property located at
(Address, Lot, Block, Road, etc.)
on F�� (—��1'� , in CA)e N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
✓� n E I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual pmposing development must N11n description below or attach a s/te drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
M O L I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
C,
Print or
2
Telephone Number/email a dress. II
533'oe1
Date L I I r, I 14
(Add, con
tt Property Owner Information)
. ranah+ro'►
(Revised Aug. 2014)
LOM

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