Piner, Audrey 76641C

41iCFE
DREDGE & FILL N9 76641 A B 1 / D
LPERMIT Previous permit#
Nodification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality nn
and the Coastal Res urces ommission in rea of environmental concern pursuant to 15A NCAC V
attach
Applicant Nametii j Project Location: County
CVIAddress Street Address/ State Road/ Lot #(s)
City I State ZIP
Phone # rp Mail L1 �1 Subdivis�'o 1 A
n Of I 1
LLLT/n
Authorized Agent I� /1' ]�
Affected ❑Cw X7 EW
AEC(s): ElOEA C❑ HHF
❑ PWS.
ORW: yes / n(�v :( ) PNAy(e�sj/
Type of Project/ Activity 1-4
Pier (dock) length
Fixed Platform(s)
Floating Platform(s
Finger pier(s)
Groin length
Bulkhea ftiprap length (�7J
avg distance offshore
�'�
max distance offshore,_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlif�
Beach Bul�lldozin
ul/
Other —. -PA
Shoreline Length
SAM not sure yes �o
Moratorium: n/a yes no
Photos: yes
Waiver Attached: es no
A building permit may be required by:
( Note Local Planning furisdic i n)
Notes/ Special Copditions
or Applicant
IES LiPTS
BA ❑ N/A
Phone #
Adj. Wtr. Bodk�
Closest Mal. Wtr.
ZIP
(scale:
f'='10 )
See note on back regarding River Basin rules.
Fee(s)
statement
0

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: R✓C�_ f1 1� "ems
Mailing Address: P () `-3ox 2 10 2
Phone Number: ^n(l`� -- 110U �l7Uf�
Email Address:
I certify that I have authorized i� G�j (?e^^
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: ce'e c e.
n AC { 6rz nk CAyCk L r- t?K
v
at my property located at
in CcC \..er-e--E County.
l 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:
l,U(Ft.'UI���Ghi�t
n Signature
Y1U ((J' M- T
Print or Type Name
\
Title Q�ed
Date
This certification is valid through

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 30 Davis �VGt s
(Name of Property Owner)
property located at G b
(Address, Lot, Block, oad, etc.) N.C.
on �0q!19 SC)u �2 In
' (Waterbody) (C1tylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lopat
)Wt/ ion. I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing d vtlopment must fill in description below or attach a site drawing)
05 Oct <
r�(I
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 Information)
(Adjacent Property Owner Information)
AMP -FOP
Signature
KCer-on CPrunr7ot )
Print or Type Name
14 q Moere' iLvr
MailingAddress(I
r, S h Gc S
City/Stafe(Lip
Telephone Nu ber
Dat— e --ram'-1
(Revised 6/18/2012)

f rooerty Owner information)
care
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to of Property owner)
property located at (Address, Lot BI k, Road, etc.) N.C.
�� �(�
on i�r� /e in 1(CitylTown and/or County)
(yyaterbody)
wn below, the development proposed at the above
The applicant has described to me, as sho
location.
tL_ I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPPAENT
(individual propo 1 ng dave��p; enf must fill in description below or attach a site drawing)
Ry" 'C'1,V
b C�0
e
WAIVER SECTION -- ---...
" I understand that a pier, dock, et
mooring pilings, breapkwater, boathouse, lift, or groin mu be ou
back a minimum distance of 15' from my area of riparian access unless waived by ( Y
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.
— (Adjacent Prop Owner Imormat•ff
n�)
Signature
YOZ
Print or Type Narqu- r7
Telephone Number
S- o7- —
Date
(Revised 6/18/2012)