Evans, Max & Kirsten 80406C

LAMA /AIDREDGE & FILL 80406 A B
ENERA►L PERMIT Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue DatZprous 'ermit issuedAs aut orized by -the State of North Carolina, Department of Environmental Qualityand the Coastal Resources Commissi n In n area of environm,�ptrlLcmcern pursuant [o ISA NCACules attached.Applicant Name 1 -/f /1 Project Location: Count
no. n t a. d 112 A n Street Address/ State Road/ Lot f (s)_
Phone # l7�
Authorized Agent
Affected CW
AEC(s): 00E
WS
ORW: y ! o
Type of Pr jest
PNA yes /
Activity
/ City.. ( ��
ES ❑ Prs Phone#
[]USA ❑ N/A Adj. Wtr. Body_
t,
Closest Maj. Wtr. Body
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Finger piers)
Groin length�'�
number�
Bulkhead/ fUprap length_.-,1
avg distance offshore i 11
distance bore I I- _ .. ...... .. .. _ � . :. '. .. .!. _.
C
A
ZIP
I I �
cubic yards
Boat ramp_-
Boathousaf8oatlift
�^
Beach Bulldozing-
-7-
Other
Shoreline Length I a'
SAM not sure Ryes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planningjurisdiction) n
Notes/ Special Cogldifions
Fee(s)
�. See note on back regarding River Basin rules.
Signature'' '''}�i.� r
li�i g�Dale! "

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: max VvJ l�'s� ✓a y
Mailing Address: �3( oeer cock �r
Phone Number:
Email Address:
I certify that I have authorized
Cute- (o✓Jrvd A) IfS Ky
1;K- 4 to -off 55
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
Ojeot,, of �Oc,V &SI"")
at my property located at h 3 S nePi ((ec k
in (161(,d County.
1 furthermore certify that 1 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:
11�7
L
A^ Signature
Print or Type Name
_Q urJ�e�
Title
N, I lCA I S
Date
This certification is valid through I I

ADJACENT RIPA taN PanaFary nwuGR QTATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at 5�� Qtf c l`e� Qr
on QQPr creep (Address, Lot, Block, Road, a c.)
in lt,lt C�/a�seI
(WaterbodY) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the a
to on.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
Ond/vldual propos/nN development must flit In descrlptlon below or attach a site dray
63 d�
o�
3�
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 waive
me;Y you wish to waive 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 requirement,
(Property Owner Information) (Adja�egt p operhtOwner.Informatio
LA 7(.�'C
dgg56`A
(4M
Telephone Number/small address
__ _L1p '% DOI l
Date
'b-AZ N L 7,8s By
Z`is� �✓�rt�.Nk.rJzY
irl small address
(Revised Auc. d'

I hereby certify that I own Property adjacent to OA ("X L jc'%4 's
Property located at �f 5 Oed I ree / (Name of Property Owner)
on per' CrcP_�, (Address, tot, Block, Road, etc.)
in Wf I Gahm t N.C.
(t+Vaterbody) (Cityfrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must flit in dowApOw below or attach a alto draw/ng)
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 15' setbacc requirement.
I do not wish to waive the 15' setback requirement.
(Pro art/y�Owns Information)
(Adjacent Property Own Information)
a 6s
Si$n�atu
.7 e• 1
1 1� � 4e"-"e
Print or Type Nome
L SM rcreek Or,
Print or Type m
'-AT Biro- r-ov- �!
( - n. -AddressAddress
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(Revised Aug. 2014)