78122A_Cavanaugh, Patrick & Anita_20210504

✓CAMA / DREDGE & FILL
Cf. ENERAL PERMIT
New t'lixfiG;.ric,n Cw ii� c[t kt-e..;;t I'a! t•,tl f',i' »,-... l rir. il 5 :' Su�•d
As 3�tt �:!icy+ Lr tl!c `_� tie of fJ, , .1: Cardin;, Dcp.[:'tn,.,,•t �'•f E t ! ,r., ! Qualay �� � �'. �
and me Ioastal Resources Comnu.,s!on m w: area of envrroriwenLai (.c .:r p.;rt.ua!it tc I )A NCAC
Rul;., .rttec+.
Applicant Name Fa,4 ;ck., Project Location County
Address sfe `L 1 Street Address' State Road- Lot #.s, f qJL,.i,l
City State/A:� ZIP �`�d`i Sl�ofe ��r• t,tr ' (� f! Y
P,tone # F_M.,il rt �c=aU .cql�'�:::Ut.{c'j'Subdivlsion (:1Jt•/fkC/, Qti t`,—
Z^C1
Author:zeJJ Age+ r t �— City�f cf t n t+,-C' e ZIP
Cw ✓EW PTA ES PTS Phony it krvci Basin P--Y ,j (M
llffectcd
AEC(s):
OEA HHi IN UBA N,A Adjtr y
WBody >br, t4,-,-`
Pws _ ,^
`PNA yes no Closest Mal. Wtr. Body
ORW ye; � _ice t ��^��
Type of Project%Activity &,C_>?- _ f__uiS, L; C4-
(scale: PT �, )
F xc plat,
r fr • r�
.J� A
Finger pier(%; , yy
s1 Ct l t u " r
Groir� k•rtpth ' P � � T- _
-�ber
Bu;kt,eau Rpraplength
a.g i,,- Ime offsh, e
L '
i
Boat rin:()
Boatho,s'y/ Boat if
t4I
5Av „IA 5'.1rC r— �� I
MOfatrlr,j•)/
Photos 5 rx; Qrp J ( LGtc:- ;
Wa+ver Atta,_I•cd ?-es 0 no LL
A buildmy perm t may be regwred by T t TLC -- __ -_ _ - __ See note on back : egarding River Basai rules.
Note Local Planning)ur,sdicuoni
Notes: Special Conditions �_Qt i j . u— y- •':._ _1 =1_ �.r 7� 1 —_i1�s �a�- — ✓i�l�'r•
>(Ato_ �v
Dent or Ap:*,. am Pt,nted Name
Pirase read comp4ance s[aterner.t en back of pern,'t '
.:. orb qo3�
Appl,eaucnFccts+ Che,i, �
r *tlture
Issuing Date
I -Y -�-I
L, P.ratir,n Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _FC1Tfttt S�
G
Mailing Address: 1`�� ��� �► u 6 /'
/VC 27�
Phone Number: �7— ie�Ci —G693
Email Address: (� 0 , - -k (SyVhC &4, _ !.v e
I certify that I have authorized�,,,I��`S
Agent / Contractor
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 Chlri �-�.c L� County.
l furthermore certify that I 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.
Print or Type Name
Title
/ 2Z U1
Date
This certification is valid through. -1 /1� /

I hereby certify that I own property adjacent to 1'Ct41(_. 4— � t 1���� 's
��NamT of Property O er)
property located at 11TY,
on �I k �/ � ( ddress, Lot, Bloc Road,
Y,(1IfUC� 4�� in k N.C.
(Waterbody) (City/Town and/or County)
The appli ant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
rG�
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.
ropelty Owner Information)
)''nature
-Yrhie*-
Print or Type Name
14'7 tx.y1- She, r{ Dr
M ling A dress
rii'rn cJL �L
Ciate/Zi
'��-�-3
Telephone Number / email address
3I-+Ilba,
Date
"Valid for one calendar year after signature"
(Adjacent Property Owner Information)
Sig tune
Print or TXXpe Name
�C9 C-cLrc7t(""V-
Mailing Address n
(�tA(1-1-t LA( (�- �C
City/State/Zip
Telephone Nu ber / email address
3112130
Date*
(Revised Aug. 2014)
V
1�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to afr C.�/— CQ�aila<1-- s
ii ( me of Property ner)
property located at I —Spa o a �`�16-r- L.r .
�, (Address, Lot, Block, Road, etc.
on C� (t.Y1'(C . )CLIytL✓< in 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,X _ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
sk/,
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.
voegE Owner Information)
Si nature
knjk '
Print pr Type Narpe
1 Si�u�t('� S k�. r-e 1.
Ukri11L�
City/State/Zip ''`` 11��
Ji5I- 6 36- �F ��+3
Telephone Number/email address
in i tin -LA
Im
`Valid for one calendar year after signature*
(Adjac t Zr r Owner Information)
(\ Signa e *
- �eGN �C;1 ✓l /✓lGI S
Print or Type N me
/93 L
Maili Addres
CbeI* u��c /UC �79vZ`l
City/State/Zip
757- (o 3,0 -Aa4 (P
Te/ephong N ber / email address
3/ sR a43
Date*
(Revised Aug. 2014)

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Aerial Photography (2011
■Rea: 9.ao_1
Or,;rvwm [ianasr
054ua. 64ml 3
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