Watson, Brian 80414C

Emailing: Image (188).jpg
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DI IEDGE a FILL N9 80414 A B (c ) D
E L PERMIT Previous permit# t/
ew �Modiflcation OComplete Reissue LPartial Reissue Date previou permit issued
As am horded by the Stara of North Carolina, Department of Environmental Quality r /
and the Coastal Resources Commission in an area or anviron/ enul concern pursuant to 15A NCAC
let turhad.
Applicant ame-(�_ _ Project locatlon: County —
Addre (/i- Street d Stak Lot #(a)
City - - - to ZIP - I -
Phone, # ' 'M I SubdMsio
Authorized Agent � /I _ Chy ZIP
Affected ❑cw f7PTA city
#' ( River Ball
AEC(s): Ll � XHF LfINH ❑ USA A Ad). Wtr. likill
ORW: y no PNA yes / Closest Maj. Wti. Body
Type of Project/ Activity
(Scales )
Pier (dock) length__._
Fixed Plallorm(s) �� • _ � -- � I - - - -
Floating Platforni(s)
t
Finger pier(I ,._ _ , ....
0 �
Groin length
number
Bulkhead/ Wpmp Willh"'— t -f _ • I _.
avg tllstance oRahoro a'•�— .. t I- -� -_ _ _ -.
dis4n olhh r a N,t t'✓ 'I F -
._ viv ll
he
�
Boat ramp' _ . -
goathous4BoauRr
I i
Beach BulHming•��
Other .—_._._ a _ _ _ _— �._ T
Shemin Length
SAY: mijy.
��/Moramrium:Phoem: WaivxAttached— _ �_ ----.---.--'— --
A building Parini may be required b lLa,'1d l� �SaawaRah Ilg Besin rules.
(Note Local Planning jurisdiction) -ly A 71 /dn War
2 of 3 5/24/2021,11:11 AM

AGENT AUTHORIZATION FOR LAMA P[RMIT APPLICA710N
Name of Properly Owner Requeslhig Pen»it: �321* .I
Mailing Address: 21 o -Jane 9 • At%"� r?A58,(
Phone Number:
Email Address:
I certify that I have authorized �Dc M w+ �IoPP �oR sraf.ociri c,
Agent / Co tractor J
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: L�Lti--
at my property located at _
in eokjt r County.
I 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: -
c� Signature
hLl� )rtStr� lJR75or.J
Print or Type Name
Title
Date
This certification is valid through I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I herebyccrtil thal I own ro mrt nd accnt to A (�.__ Q^ wttTie.f s
Y ! I Y 1' e J
ty, (Narne of Property Owner)
property located al---�_�-��- -- a�t"� - �--------- ----- _ _
(Ad ress, Lot, Block, Road, otc.)
on ---__ OE-GY _f fte,' .. ----._.._, in ___..0 Qt _.�otil/GY___ _ _. N C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at lhr; 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 RIi In description below or attach a site drawing)
Z
r
_ 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,
(Prop rt y Owner nform ti
lu
Malf{j(Jl1 IepS pv
clfyAtale.0p
Tolup%%g�one Number I email address
ly?�
lhnr'
'Vatid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I lie. why certify that I own properly adjacent to -- (ZI"
(Name of Property Owner)
properly located al ;2?3
(Address, Lot, Block, Road, etc.)
Oil _. u�.u' in --- Coallit eA _ _ N.C.
(Walerbody) (Cityrrown andlor County)
The applicant has described to me, as shown below, the development proposed at the above
lecahoiy
I have no objection to this proposal.
_. I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must ftllln description below or attach a site drawing)
l
� dk Sk 3 c2O`�
V1
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.
(Property Owner Information)
r7�lA-� �AfeN �A%r�7Towi
Pool or Type Name
w.. r Ct
,p gys- AA44i
Number/email address
2r/21
'V.Ihd for one calendar year nfler signature'
(Adjacent Property Owner Information)
signunpr*
Poor or Type Name
r' r l
Maibay llddlnss
Telephone Nmnhrr�' cmad address
All,
(tl,•,, 'rii A;,o ",11.'