79269A_Pitts, James & Ann_20210706

a(L
/CAMA / /DREDGE & FILL NW,
G<& ENERAL PERMIT B C D
Previous permit #�e 'Modification 'Complete Reissue Partial Reissue Date previous permit —issued
As authorized by the State of North Carolina. Department of Environmental Quality u0c,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC�_ Hoc ?I P. lacio go
Applicant Name Am, V-'4J .0,'KLdes attached
Project Location: CountyC4.ws'4CC,k . ... .. .. . ... ..
Address I
Street Address/ State Road/ Lot #(s) 2231 TW
City-. mo k-
State AX, - ZIP
Phone # (2sa _ ) 05'06PS_ E-Mail Nvf;+t;F,fe,,-W464tib;-;'-C'Zt>di0sion, C4 rouc— [?eap4!!.r
Authorized Agent City Cptoll� ZIP
Cw iJ& PTA 4S
Affected PTS Phone# River BasInF,&sft.,4
AEC(s): OEA HHF _AH USA N/A j. tr, Bodp�;"
PWS:AdW
— 4. kW* (nA. 10 /u.k.)
ORW: yes PNA yes /& Closest Maj. Wtr, Body C")
Type of Project/ Activity Veo 120 '
Pier (dock) length
Fixed Platform(s)
Floating Pwd--(S)
Finger pierls)
Groin length
number e__
(tf-Wilip-P length lJo,
an distance offshore -L
max distance offshore
Basin, channel
cubic yards to
Boat ramp
Boathouse/ Boadift
Beach Bulldozing f
Other 10, liv PICACA
till
Shoreline Length
SAV: not awe yes cr-p
Moratorium: /1 -115') dyes no _:_ I �'t ffs
a topPhotos:
Waiver Attached: no
A building permit may be required by:
(Note Local Planning jurisdiction)
Notes/ Special Conditions
on o
pficant n:nted N e
a r 'Please read cornpii e statement on back of permit"
Application Feels) Check #
(Scale: r� S;
See note on back regarding River Basin rules.
_Ro6e,car_} e-w
rnted Name
Signature
Issuing Date
xpiration Date

AG9NT AUTHORIZATION FOR LAMA, PERMIT APPLICATION
Name of Property Owner Requesting Permit: 0,70 ++ ea +�- 4-1
Mailing Address: % Z 15104 gpr/l Cs,
1_ B
Phone Number:
Email Address: gs
1 certify that I have authorized ReIR c t, �.,Js
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Ae.v (au j" .t_C1 � � �„�
lose
at my property located at i,_�! irl c Pf�n �� r? r�, i -Zalp► ' S
in Cyrr'ILec% 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 evaluafing information related to this
Dermit anolicatinn
rme
Date
This certification is valid through _G _/ 31 -t 2x>z i

PROPERTY OWNER ST&TEMENT
I hereby certify that I own prop" adjacent to
(Name of Property Owner)
property located at
(Address,i , Block, Road, t
on% , in C6 ". it .1 N,C -
(Waterbody) (Cityfto-w�­nand/or County)
The applicant has described to me, as shown below, the development proposed at trie above
locati rg222at I
I have no objection to this proposal;
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a so drawing)
A
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.,,
"All I do wish to waive the 15' setback requirement.
i do not wish to waive the, 15' setbacLLcuuigment.
(Property Owner Information)
7 lallvv 07 nj
Zlnrlt or Tvae Name
9,0. TA�J(
Malfing Address
emad address
6A 6"J5
for ore ,;atenoar year after stgnature'
(Adjacent�Zo rty Ownepinformation)
'
Signalure- kk
X I -At *0XI- JQN%;�
Pdnt of Type Name
Alai g )ftbk SA6ove--,
Address
�dwstataqip
at -] 7�,,1-7 qfr-f-7,
_�re/;Xne Ni7ber � ernail 3ddress
(Revised Aug 2014)

Owner information)
or TYQo Name
Lc� G— (.o
Telephone Number/email address
)� .C� ��(��t clsi yx�c> �, to tir
"Valid for one calendar year after signature`
AD A ENT RIPARIAN PRO ERTY WN R STATEMENT
1 hereby certify that l own property adjacent to r' s
(Name of Property Owner)
property located at 2,27et
(Address, L t, Block, Road, etc.) N.C.
on o - - in (CitylTown and/or County)
(Waterbody)
The Vplicant has described to me, as shown below, the development proposed at the above
loca
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANUOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fly in description below or attach a site drawing)
N
.L,2''tt � Z23�+c .�a.� a .� i3 L(l j►e �(,
t r t �s r � 2Z'1F tt
WAIVER SECTION
I understand that a pier, dock, moorinngs, boat ramp, breakwater, boathouse, lift, or groin
g pili
must be set back a minimum distance of 15' from my area of riparian access unless waived by ` s
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, setbac rgggjLement.
(Adjacent Property Owner information)
Signature
Print or Type Name
Mailing Addre��gss
le (L l< ) V
citrstate/�ipQL(-
elephone N er/e arl address
-- ?.
Date*
(Revised Aug. 2014)

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