Elliot, David 76698C

LAMA / DREDGE & FILL N9 76698 A B /C /D
PERMIT Previous permit# L/
ew ❑Modif cation ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Re urces Comt issi n in an are of liro;nwealcern pursuant to 15A NCAC
❑ ules attachff
Applicant Nam Project Location: County
Address Street— Address/ State ad/ Lot #
City ate ZIP OJ� �' /�I 1
Phone #tf/�
Authorized Agent
Affected ElcW ❑EW ❑PTAj
A
Affecte 1-1OEA ❑ HHF 17111
❑P
ORW: yes / to PNA yes /
Type of Project/ Activity
Pier (dock)length�
Fixed Platform(s)
Floating Platformri-
Finger pier(s)
Groin length
ber
8 kh / Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach
Other
Shoreline Length _
SAV: not sure ,. yes
Moratorium: n/a yes o .0
Photos: yes l no
Waiver Attached: � / no
A building permit may bve required by:
( Note Local Planning jurisdiction)
or
❑ PTS J Phone # �ip gL
❑ N/A Adj. Wtr. Body
Closest Maj. Wtr. Body
Oq-
See note
ZIP
River Basir
(Scale:
RiveGBasin rules.
on
//x/ira/tio6a

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 00-uli A LTL L (1:v
Mailing Address: Lio b' Lee b" I-
8\1a--yr 11CAC,
Phone Number: 9 l 5 - Z 19 — 600 if
Email Address:
I certify that I have authorized
— t Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: S eo--3,,— � I
at my property located at \Ao V L_,--e- Z-1-
in 0 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:
Signattuie
� eve -A L l `-pjt
Print or Type Name
/N-rvLl
Title
K l
Date
RECEIVED
This certification is valid through 16 1 Z`t lZ-1_
JUL 01 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1)QN-
(Name of Property Owner)
property located at DOf e S
(Address, Lot, Block, Road,P�� N.C.
on 1 K�r✓ , in J�-l-ll-,-l� G �S
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Via\ to on.
' 1 have no objection to this proposal.
I hav�oltjections_tQ this_pr-oposaL----.-_----------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
131
/ '6 L tOtt
kJ
vrkl WE SE TION . —
I understand that a pier, dock, mooring pilings, 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.)
AI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
ature
Print or Type Name
Uva J n.P_ C
%eoaL iiC 704'Z
Telephone Number
19 'LK � 2e7
Dare
(Adiacent Property�Owner aformation)
'''�
Dare
(Revisli6108hooN
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to '^Nef—t)Pk— s
property located at Le' e- bri-
(Address, Lot, Block, Road, to.)
on "fi t' SD ✓ .C� in _ 414 `, C ` Pea t" N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
aL loca
I have no objection to this proposal.
-- ------�-p�_ve
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below or attach a site drawing)
�Gu,I
5 /NA,1L
A {
ell �r
"Over, t
__
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 1 rmation)
Print or Type Name
wd it Leff e- -
G¢yiara[eiup
_0l1`( -2!°I_(y?�
Telephone Number
-211-2d
Date
(Adjacent Property Owner information)
Date
RECEIVED
(Revised 6/18/2012)
JUL 01 2M
DCM-MHD CITY