Novak, Thomas & Sandra 80410C

Emailing: Image (184).jpg
As authoh
and the C
Applicant
k /4REDOE A FILL VO 8O410 A B �D
E L PERMIT Previous permit#
7111odigcation AComplete Reissue al Reissue Data previo s er It, I sued
e State of North Carolina. Department of Environmental Quality I
Authorized Agent ~�/y
Affected ❑ A (]ES PTS
AEC(s): ❑OPA ❑ HP ❑I' OURA OWA
ORW: .. no PNA yes I \ /
Type of Pro)ect/ Acthlty M,rp
ant to I SA NCAC
as attael
eject Location: County
Street AddreW State Road/ Lot #(s)
,�4zO CCt,&- 0 -A
Subdi/vJyyoyn,�,�/�,y�._���''��,/._/,�
CItv(.C.(LX.I KIVf_'- 7JPSL'(496CQL-
Adj. Wtr. BodLk
Closest Mal. Wtr.
Pkr(dock)length-
FmedPladorm(r) J----- I _
Floating Pla[lonn(sj --
Fingerplitno—
_ I 'l
Groin lengthj/1/t—t
Bulkhead/ Riprap length
avg disor¢e oRaherg
u tliswce ofhhorenm
a
INXaN .-
Roar ems /
Rambo" Boats t
share. Length -/_(4 1—
SAV: notsure yet
Mormarlum: Na yes no
Photos: yes no
Welvor Attached: yee o
A building permit may be req '
( Note Loral Planning jurisdictio
Notes/ Sppdal Conditipns
I
1 by:l r.{A/.ij.LttJ`/1 ❑ See now on back regarding River
rules.
.a �p %\\ (ajIIm\e� Pem�b(Iic�s Prim 7 /
_Please read compile --t kof peLfrm�t{ity�'"a—'j� Signature •` II
Fee(s) ChgcK# 1 I 1 g u I • _— _ k_kilpirat Dat
2 of 3 5/24/2021,11:09 AM

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:�%i%QS
_ , _ '1
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
, Jnna'ffiav, Ilopo/ l a5fo
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at <
in ,GjF,=:7—County.
1 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
Signature
Print or Type Name
Title
�1 ao lam/
Date
This certification is valid through

I hereby certify that I own property adjacent to �%��� � • S,rc & f s
me of Pro rty Owner)
property located at,eJ 0 �� �Z-
// AddgasLot, 81 good e
on , 90,4 f ��oo�, in
(Waterbody) (ity/Town 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
(lndMdual proposing development mast fill in description below or attach a site drawing)
i
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' setback requirement.
I do not wish to waive the 15' setback requirement.
Dare
(Revised Aug. 2014)

I hereby certify that I own property adjacent t�� �� s
I-, (Name of Property Owner), I
property located
on in
(Water)ody)
The applicant has described to me, as shown below, the development proposed at the above
location.
J I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND10R DRAWING OF PROPOSED DEVELOPMENT
(1ndlrWW1 propoaing development must all in dssmtftn below or attach a site draxdnp)
Loy
l: r T4 OEV
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' setback requiremenL
I do not wish to waive the 15' setback requirement.
Date*
Owner Information)
Gel
0 3 b' 9 • 7,;2 It L.
(Reviser) Aug. 2014)
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