Dunnehog, Marianne 80405C

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AMA / upAEOOE a FILL N9 80405
ME ^"r PERMIT _ previous permit# —
New E Ificatlon -]Complete Reissue �artial Reissue Date previous
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Asa riaed by the State of North Carolina, Department of Environmental Quality t
and the Coastal Resources Commission In an arm of environmental .n tan pursuant to I SA NCAC
Appilcant N e %'t �p!!4^C/nt�,AZ, Protect Locatlon: County_..
Street Address/ State Road/ Lot #(s))
pw(do&)length I
Fled Phtlmm(s)-
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Famal pier(.)'—
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SAV: notYa n —
Norawrlum: t/a yes no-
Phows: yes no-
waWrAttched: yes
A building permit may be required by _7 See note on baJcfs rreeg+ards/n,y{{�w� Min rules.
( Noted LoPlann'mgJurisdittbn, n r //1 n in ® n s Op /% �//il /A 1 //1.//
2 of 3 5/24/2021,11:08 AM

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ��/ N��� �% (/ L` /✓c
Mailing Address � � n {� l r( v__!
Phone Number: 39 SL6 0.7
Email Address: N 6-Zil 0 CCy V'
1 certify that I have authorized JC,✓I I 1 �� n Ag l � `
Ag /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: K�, M ( N l /
/emu 1
C)Al �aA7 G-fl�- Fc ,� 7',41c/1Z-tI-,-r✓7'
at my property located at
in OK7,erWC7- County.
I furthermore certify that I am authorized to grant, and do in fact grant permissioi
Division of Coastal Management staff, the Local Permit Officer and their agents to e
on the aforementioned lands in connection with evaluating information related to
permit application.
Property Owner Infonnation:
Signature
Print or Type Name
Title
r 20 zl
Date
This certification is valid through 1 1

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w.n,wtrsNT RIPARIAN PROPERTY OFAIRMIMstLT
1 hereby certify that I own property adjacent to y (Name Of Property OwneO8
r)
located at 5
3' SIZ �(rt7K tub'
property (Address, LOW, Block, Road, etc.
) I+iq,r7tl+c °ovNYy
in 1 n.= (' P4-ft7� K �7 ,N.C.
on (Watel'body) (Cityirown andror County)
The applicant has described to me, as shown below, the development proposed at the above
toc�0 -
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must dBl in dsscrl below w attach a $ite drawing)
��u✓C- `jiL7 / Imo/ d ✓9 Uti�cy 08> G F7
yq i Tr�CI� 1 EA17
WAIVER SECTION
1 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.)
el I do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Irrformatlon) (Adiacent Properly Owner Information)
(Revised Aug. 2014)
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I hereby certify that 1 own property adjacent to im /fit V 41 r , /1IV 110 s
q (Name of Property owner)
property located at 537 7)C;8)e
(Address, L , Block, Road, ete.)} t+�,c7�-nc Pov.v*
on . in !'r�L" (' s4fi7' C 61, N.C.
(Waterbody) (Citylrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
tocatiory.
i1 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndlvldual proposing development must fill In below os attach ash* dmw/ng}
C�Ia✓F /t-7, r.-y 6 ✓v U��c� 0$7 /,
i cy l¢ -r dC'NA46-A1T
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.)
i do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner information) (, dJ csnvnf p Otl Information)
v„rivw.wrq.
I 2_ 29 3-
telephone Number/email address
Date
(Revised Aug. 2014)

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