Dixon, Bert 76689C

/ ❑DREDGE & FILL N9 76689
FEERMITRAL PPrevious permit#
WNModification ❑Complete Reissue , ❑Partial Reissue Date previous neri
As autho ized by the State of North Carolina, Department of Environmental Quality
and the Coastal Res rces gCom-�m-i-ssion�in an�area of environmental concern pursuant to 15A NCAC
Applicant Nfrpe i V /1 Project Location: County
Phone �j r'
Mai^n
Authorized Agent
❑ CW ElEW
❑ PTA ❑ ES ElPTS
Affected
A
Affecte ❑ OEA ❑ HHF
❑ IH ❑ UBA ❑ WA
❑ PWS:
ORW: yes /. no PNA
yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) 1
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore �i
max distance offshore
Basin, channel —
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach
Other
Shoreline Length
SAV: not sure y s no „.
Moratorium: n/a yes no -
Photos: yes no
Waiver Attached: yes)
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Speel Conditions /I
Phone #&—DZ')
Adj. Wtr. Body
Closest Maj. Wtr.
N
A B IC /D
Basin
f
(Scale: ✓� )
Basin rules.
read
Fee(s)
Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting P�ermit: lkr 7 br x�
Mailing Address: l iPGI �-frrc4ce C-1-1
Phone Number: Q-I LSO
Email Address: /
I certify that I have authorized lL1y11 Orl-j Y �i I ?VY54 Q in k� M rt n (W1
Ag t / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits t
necessary for the following proposed development: S XSC hD�.SI�tiIZ�[ k
hf�jS�cL—I-
at my property located at
in�& 1"� 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:
E�hed+ _bixnk
Print or Type Name
Title
D6
Date
RECEIVED
This certification is valid through l I JUN 10 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C-J-AzSzr l) 'Aroo % 0 ) /V,)• Vs
// (Name o Property Owner)
property located at W �`' ✓9c
(Address, Lot, Block, Road, etc.)
S on O q UC S0(j r j in v N.C.
(Waterbody) (City own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must 1111 In description below or attach a site drawing)
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.
(Property
Date
I do not wish to waive the 15' setback requirement.
2 X ss-y
O
address
''Valid for one calendar year after signature'
Property Owner
—1 2Ci .yR / G/ .
=� I cO
(D ' X dU
Date" RECEIVED
(Revised Aug. 2014)
JUN 10 2020
DCM-MHD CITY

RECEIVED
JUN 10 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4 G51-1 T/Xa.y s
(Name of Property Owner)
property located at 1 J C'-Jn( c Zap -
(Address, Lot, Block, Road, etc.)
on /3OGUE SOUND 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.
I have no objection to this proposal.
----l.have_objections_tolhis.proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Sep, ,�,,a 41�
--------. 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 O ner Information (Adjacent Property Owner Information)
-
C/� U
Signature Signature
���LS(zC I'� �r s/ L'DaSTHNCE S. Gfa�12�'T✓—
Prin r Type ame Print or Type Name
Cl C )i 9/0 O.qi zw-
MaimMai' ddress Mailing Address
�R-_ �j� .ttaa.2E.�EAD G'/YLI NG' 28SS7 626
City/StatelZip L� S. _ City/State2ip
J W�.9-6/o GooB
Telephone Numbe Telephone Number
A-11511-
S Ll � `lor) O6//-7z/9
Date RECEIVED
I}6 Date (Revised 6 (113 2020
DCM-MHD CITY

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