Waters, Malcolm 76692C (2)

CAMA / ❑DREDGE & FILL N9 76692 A B 6D
ENERAL PERMIT' Previous permit#
Ne❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permm 'ssued
As authoriO,edwby the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in a area of environmental concern pursuant to I SA NCAC
R es attached.
Applicant Name Project Location: County _
Addre © Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # p
Authorized Agent
Affected Cw EW PTA
AEC(s): OEA HHF ❑ H
❑ PWS:
ORW: es no PNA yes
Type of Project/ Activity
Pier (dock)length
Lo—
Fixed Platform(s) r
Floating Platform(s) V,
Fingerpier(s) —'
Groin length
number;�
Bulkhead/ Riprap length
avg distance offshore'
max distance offsJiore
Basin, channel
cubic yards
Boat ramp
Boathouse/ tlift YI�t
Beach Bulldozing_
_/
Other � f t(�(/)(
Shoreline Length
SAV: not s7yeno
Moratorium: Photos: Waiver Attached:
A building permit may be required
( Note Local Planning Jurisdict(o�
Name
❑ES ❑PTS
❑ UBA ❑ N/A
X)Q L l��
Phone # &nN
Adj. Wtr. Bodys
Closest Mal. Wtr.
note on back
ZI
(Scale: I ✓ V f V )
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Tnature P/egse read compliance statementon bat ) **
^j /
ication Fee(s) heck #
Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: I " 4�CD�AA W ri µ ers
Mailing Address: -3o 3 cave Pbr,,74—Ca
CRAP /j 6, 7�5'
Phone Number: 2- SZ-. % 51 0 5 71
Email Address: � //��4/ Id IM Kf le Wq4-e(S('a,j *C/(�tq. �0•�
I certify that I have authorized 1 S t t"l OZIi l) 1CS J
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:
tied d6'1C -�- Lt
at my property located at _
(, in lOh" '6�ounty.
I 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.
Property Owner Information:
Signature
141�'✓ 5
Print or Type Name
e,r�
Title
/ z'C / Z/0
Date
This certification is valid through l.?-- / W ( / 20

I hereby certify that I own property adjacent to
property located at
on
03 C
(e-teK
a'Co�M �l�t ors s
( e of Property Owner)
y8lock, RC 0 ek -" � , N.C.
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(cityiTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
`—ir
\/ I have no objection to this proposal.
1 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)
wervFR SECTION
s, boat ramp, breakwater, boathouse, lift, or groin
I understand that a pier, dock, mooring piling
mus be s wish k a minimum distance of waive the setback, you mufst Initial rom my the appropriate blank belrea of hiparian access ow.)
waived by
I do wish to waive the 15' setback requirement.
--Nw ✓ I do not wish to waive the 15' setback requirement.
Dare
-Valid for one calendar year after signature"
C1ty/stathaip2�Z zy� S3 SS'
Telephone unmberleemp4 address
Date*
(Revised Aug. 2014)

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