Starling, Bryan 76751C (2)

LAMA J- DREDGE h FILL NO 76751 A B C f D
ENERAL PERMIT Previous permit#
ew ❑Modifiation Complete Reissue ❑elssue Partia Date previous rmit Issued
As aut rized by the State of North Carolina, Department of Environmental Quality ' ! r
and the Coastal Resources Commission in an a ea of wAroomental concern pursuant to 15A NCAC R.
Applicant Name L Project Location: Coun `
Address r Stree Ac� ss/ State Rod/ Lot #(s)
C ty ^I State ZIP
Phone # 41L) rr2
Authorized Agent
Affected C3CW
AEC(s): OOEA F IH
❑ PWS:
ORW: yes / ® PNA yea
Tjrpe of Project/ Activity
Pier (dock) length `
Fixed PladonrO)
Floating Platforms)
Finger
Groin length
number —
Buikhead/ Mprap length
avg distance offshore
max distance offshore=
Basin, channel
Boat romp
Boathouse/ Boadift
Beach
DES ❑PTS
❑USA El NIA
Shoreline, Length
SAV: rrot suro Yes no` - —1
Moraterlum! rJa Yes
photos: Yes -- }
Waiver Attached: Yes 1---
A building permit maybe required by:
( Note Local Planning jurisdiction)
Fes(s)
Phone #7i4
Adj. Win Body_
Closest Mal. Wtr.
Basin
`{ ! (Scale:
L
i
I
El See note on back reg ing Rive
anted NiAnfi

4LAMA / ❑DREDGE & FILL N° 76751 A B V D
ENERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previou rmit issued
As auth rued by the State of North Carolina, Department of Environmental Quality %% r
and the Coastal Resources Commission in an area of enviropmental concern pursuant to 15A NCAC I I
Rules act Shed.
Applicant Name Project Location: County
Address ,1 StreejAd Ts/ Sgte Ro d(Lot #�)(s) ^n
City V State ZIP O`1 II cJ S� l
❑ PWS:
yes / (CY PNA y�

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: y
Mailing Address:
! 21 S . SPt�01'JjF-0 5 sfE�
v�Ffff�.q c
Phone Number: 2,4 ;�'> 0q
Email Address: �/�
I certify that I have authorized Aoenntractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA perm
necessary for the following proposed development: Acl
at my property located at I g ( S
in CAOCIr..y.�ounty.
/2 S t;-:-16( g-1-10A,-\
S iPoflA.)CV'zs S -r�'
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:
tvL
nn Signature C
o� 0. )fo'r II r
Print or Type Name
Title
d`� 1 )-5 1 zd
Date
This certification is valid through I ;?— l :� 1 I Z�

r_*
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
rz ,qrJ STD Llrj ,s
Name of Pro a Owner)
property located at 1 Z% s s%�U�^y�5 5
(Address, Lot, Block RoaO, eetc )
on SPdf�nJ�S �10�<, in iyU�l=l77"'A-,� Cy-f-v 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.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must till in description below or attach a site drawing)
Lid
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.
i�1 do not wish to waive the 15' setback requirement.
(Property Owner Info r ation) (Adjace P roperty wnec Information)
'
IJUle
CO,,1
Dare
,•v NC 2sss7
email
*Valid for one calendar year after signature*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hAreby certify that I own property adjacent to 2�zo
m—T S �.q-fz U� 's
Name f Property Owner)
property located at 21 s SPUO^-/�5&5 .5
(Address, LotBOock R a , etc.) C / N.C.
on �ji�oD^J�5 CQ�<,in
(Waterbody) (CitytTown and/or Coun )
The applicant has described to me, as shown below, the development proposed at the above
loc�tron, .i✓
r� v l�U I have no objection to this proposal.
I 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)
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.
I do not wish to waive the 15' setback requirement.
(Property Owner Inf rm (Adjacent Property Owner Infoppion)
June Armes r�n� �0@rcr�M�l1'A,,r\—
', 1 ure S'gnature * D
r, a,. W. S F� (�
Print or�ype Name t t Fr Ty e N e
Njling Addre s yy M W ng , ress x t C c� a 7 q
�i
fir_ C IN NC Z$55% I / let avn , l V U t
( t1Y(/State/Zip n 1L 1 CiwS/tate2ip j /- �j
-4tii 2.t inQ Q'I Ilrt ��l'I �Q`1S 1R��'i.w Marine, crn'n .l��l r✓"mil �'lI - � ( `�/
o4
Dare
address
q
/
(Revised Aug. 2014)
`Valid for one calendar year after signature`

4/21/2020
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