7807A_Webb, Faye_20210523

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-. Y] CAMA / ❑ DREDGE & FILL V_\AA'�.X ND 78070 A B C D
GENERAL PERMIT Previous permit #
El New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
Applicant Name WC fob
Address `-i
City j, Za uk.A-h State ti( ZIP Or:
Phone # ( ) - �`-! - )(o`% E-Mail
Authorized Agent y n , , r i
Affected ❑ CW ❑ EW ❑ PTA ❑ ES y] PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
..............................
i
... ...
..... ...
_
....-...-
...... -........
-
Beach Bulldozing
Other
i
Shoreline Length
SAV: not sure yes nq._._...._.
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
•
._...
....... ....
...........
.
..........
A building permit may be required by: (. O �G r �0(.1 r,
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent pli Printed Name
�'t '"C
Signature * Please read compliance statement on back of permit
Application Fee(s) Check #
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City
Cc1" ZIP
Phone # ( ) River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scale: i vo )
❑ See note on back regarding River Basin rules.
ri
Permit Officer's Printed Name
aA
-14
5431-L- '3h 3 / Z
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
ime of Property Owner Requesting Permit: Eq� e We &9
filing Address:
Phone Number:
Ll o jC1,1 C -Drj , e,
.).- a &t-l- 36 qS
Email Address: Lee j den ry-teti-I n e Ci Yo1&%rA 1 ` . C D ^-L
I certify that I have authorized Lli
/''' Cir' A e , '7 nt C.
Agent /
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
4e..4;4 ( t L( (V14i.� v`.
at my property located at _ L/ D "Ol-
in4-yjtjv-�(Ak County.
k W e& d
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:
�- Received
Signature
Fo- . LO e- b�
Print or Type Name D G E C
Title
l —1 1 o
Date
This certification is valid through 0 t / 0 / �ItO

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I certify that 1 own property adjacent to FC Al e, We. 4 Q 1�
r located at 4
(Name of Property Owner)
f7 of (q., t'_. D/'; -�
(Address, Lot, Block, Roa , etc/
f 41!e R: ✓t/ in Citgy�y�t
N.C.
(Waterbody) (Ch/Town andlor County)
Acant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndry ual proposing development must fill in description below or ai#ach a site drawing)
`Tv ki, sou I( Ll oo/- -F
VII ( eutk0e&d
Received
i 2P2)
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)
Signature
�l IMe
Print or T pe
�{D�,,, lgne Are • �
Mai/PN Addc sqfee n c a /I etc)
Q`y t, t-(- 3 Ys
Telephone Number/email address
rMN
*Valid for one calendar year after signatures
(Adjacent Property Owner Information)
sign�twe*
[un'ZN12.2 : , 1+4#4ifeAO,Sk
Print or Type Name
Mailing Address.
Te�2,
/emar7 address
Date*
(Revised Aug. 2014)

7*
, ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
certify that I own property adjacent to e. we (3 's
property located at b �, ' ct ✓� e. 0 r; (Name of Property Owner)
(Address, Lot, BI , Road etc.)
on '; M e NS1940
R i ✓B/ . in 4C; � A , N.C.
(Waterbody) (C /Town and/or County)
The applicant has described to me, as shown
below, the development proposed at the above
kocatior�%
i/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
MICIWi l pmposing die a rient must fill ire description below or attach a site drawing)
It yao -- I/A I �LjIkgetAd
�o t �s-I�. / `1
vL
AGM.
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 raaived by
me. (if you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement
(Property Owner Information) (Adjacent Property Owner Information)
Signature
FGtie- W
Print or T e N
do brI ✓ IL
Mailing Addrtgs� Q
-36 �s
Telephone Number/email address
Date
`Valid for one calendar year after signature:
Si,n,ri
Print or C SIv �bhL--
—� YAe Name
M m Address
%'ny"z
Teleplf
NupibW
/ em it address
`zd
Date*
(Revised Aug. 2014)

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