Roberson, Michael 76753C

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AMA / ❑ DREDGE & FILL N9 76753 A B (OD
ENERAL PERMIT Previous permit#
ew ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
4the
d by the State of North Carolina, Department of Environmental Quality
stal Resources Co mission i an a o environmental concern pursuant to I SA NCAC
Rules- ed.
Applicant Name �� Project Location: County
r
Address Street Addre / Stat�ad/,.lot #(� 5)� n
City _ State' ZI
Phone # cd) h
Authorized Agent "`(
Affected ❑ Cw f�EW TA
AEC(s): ❑OEA L7 HHF IH
❑ PW
ORW: yes / o PNA yes /
Type of Project/ Activity
Pier (dock) length_\
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshc
max distance offsh
Basin, channel
Boat ramp
Boathouse/
Beach
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required
( Note Local Planning jurisdiction)'
Notes/ Special onditions
❑ES ❑PTS
❑ UBA ❑ N/A
u
City
Phone # gBody
Adj. Wtr
Closest Maj. Wtr. Body
ZIP
(Scale: J _
❑ See note on back regarding River Basin rules.
Of permit **
Feels) Check# Issuingbake / `Expi on Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
LNO Cjx&,Ie_s Bird
ree+� tic Iy( ales?
a5a `ifs -727y
111 k�0 5c,I_FE.k5, (-d. ,
I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: /r, x /3 / K°v/ O'C
at my property located at Z_S_Y ?&,e5zw C/,ZcL,-
in CIK7/ c' - i County.
l furthermore certify that l 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
Print or Type Name
Title
Date
This certification is valid through S / /� / 007,1

.__.__�._._....o....�...,,.,,.,awa,.awvnu+meu,cunurtuivuwnnunuwmwmmwmLxw,unuM'JM9YGY.ZiCAtlYtlRUPo�1'�
CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: /1i/ew,oE1- '7c&x501'J
Address of Property: 2' 3 PLGAR� �'rRc'4l. Nl� P°f /mac `�' �P �.9ti
�I (Lot or Street #, Street or Road, City & County)
Agent's Name#: A/uDR� ��&/�3 Mailing Address: 3y/3 esz-p
Agent's phone #: .Z S L 66S c�3 %h /` ('�' /V,: 0S67
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
96— I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DC&9 in writing within 10 days of receipt of this notice. Contact information for DCM offices is
availableatl �.*MknAv.12c;- aPUwe b/cm/sfe.r lk7,1n,c;orbycalling1-888-4RCOAST.
No response is considered the same as no objection if you have been noted by Certified Mail,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
37+D
Mailing Address
Gn2k'nu,' l I Nc-
City/State2mp
ar n p caner Information)
/Signahrr•e
JE<F,eL�y ,r,N Lt
asa 96a.-2977l &?l k e Q Scl rEkS Cora
Telephone Number / Email Address
Print or Type Name
a�?Y9 PC-,*'tiSpN Clj2
Mailing Address
A115WAeZ7 RVC 29'100
CiWstalemp
?/9 S3W-SV3
Telephone Number / Email Address
��Fsras�rrel(®��nA I,CDVK

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: '?_0 Szr
Address of Property:' j�FON`e J 'rn2c'L /'�l-!emsi'0
(Lot or Street #, Street or Road, City & County)
Agent's Name*
Awytl�---
f &T
Mailing Address:
3M/
Agent's phone #:
L•S 2-' 665;
113 %h
N<N &-glv
fyr. as'S
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. Mgr scri •o or drawina, with dimensioi�_s,•,_mu�t pbg ovi ed v&h t. his It— tLr:
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCMj in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available
r/hRner ,t�ce s f eae%€ r h =Vcr;d!-,orbycalling 1888-0RCOAST.
No response Is considered the same as no o — ction fi you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.)
1 do wish to waive the 15 setback requirement.
I do not wish to waive the 16 setback requirement.
(Propert O ner I fo r at
(Riparian Propertner Information)
SYign—ah—ir a Signahr •e
) b,-t
Print or Type Name Print or Type Name
3`740 ejl rles (31v a5c) 'i>u,;�,� r✓'I��_I�
Mailing Address Mailing Address
he-iLJnnr'f lyc �1t9.5 1c;
City/State2ip City/State
Telephone Number / Email Address Telephone Number / Email Address