Starling, Bryan 76751C

cAMA / ❑DREDGE & FILL N9 76751 A B 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
n
and the Coastal Resources Commission in an a •ea of environmental concern pursuant to I SA NCAC ' /
Rules att Shed.
Applicant Name Project Location: Coun
Address ,1 t Stree�Ad�(rTs/�qt Ro d�Lot #(s) A
CityV State ZIP OO�hI II
Phone # =o1l
E-Mail
Subdivision
Authorized Agent
l/i
City
Affected ElGW
�TA ❑ES ❑PTS
Phone# � I�
OEA HHF
ElW
AEC(s):
� IFI ❑ URA ❑ N/A
Adj. Wtr. Body
El PWS:
PNA
/
Closest Maj. Wtr. Body
ORW: yes /
yes o
Type of Project/ Activity
Pier (dock)length —�
Fixed Platform(s)
Floating Platform(s)ql�g
Finger pier(s)�
Groin length
number'
Bulkhead/ Riprap length `—
avg distance offshore
max distance offshore
Basin, channel
Boat ramp
Boathouse/ Boatlift-%—
Beach Bulldozing
Shoreline Length I lk-/ I I it r l I I (/ %s 1
SAV: notsure yes (n0
00\ - —F -
Moratorium: n/a yes
Photos: yes o _ ff -
Waiver Attached: yes -- j r --
A building permit maybe required by 1 rV c e4act ❑ See note on back r
( Note Local Planning jurisdiction) L`
Notes/ S ecial Co ditions ( I J
t or Applicant Printe Name - PermitOffcer's Pi ned t`I /
L
Signature *'*EteaS'eread compliance statement on back ptperQiO-1; rN Siignattlre j
Basin
(Scale:
River
Fee(s) Check# Issuing Datel txpiraXon Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
9f2 �4rJ s-7 4-2U rJG-
Name of Property owner Requesting Permit: y
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
5, sPbo,-J5�95
vr�FCItJ
STgr5453'-
212 , bq rf
041 S�e_-r f4l ll r f A44' k0kf . Cc -)III
Agent/
to act on my behalf, for the purpose of applying for andZkI
ll CAMA permi
n
necessary for the following proposed development:�
�S�iGLgT(��
at my property located at
in C411CTU��ounty.
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:
9�rL
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Signature
Gr- a""' 01, Vf0.(-I1
Print or Type Name
Dw�
Title
4 y` 1 )- 3 1 20
Date
This certification is valid through i '�—' l "� I I �'

I hereby certify that I own property adjacent to
property located at 1 2 s ' 5py1]i✓S4
(Address, Lot, Bic
on 510POAJ�s �'>L <,in�
(Waterbody)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ST.9--rz ukJG- 'S
and/or Cou
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
e --A► I have no objection to this proposal.
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)
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.
-- ' do not wish to waive the 15' setback requirement.
Mrnnarry dwnar information) , (AdjaceV4 Property Qwner Information)
CO,n
Dare
2
C 2 a SS%
*Valid for one calendar year after signature*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENt
I hAreby certify that I own property adjacent to 4� S -r4-fL LJYJ s
Pro
Naime of ertyyrt OO�wner)
property located at 1 s 510010:✓ S �1''
(Address, Lot, Block Roa , etc.)
on �j/�OanJ�S CQ G , in �o��� C/I'N N.C.
(Waterbody) (City/Town and/or Court )
The applicant has described to me, as shown below, the development proposed at the above
loc9tfgn
e� V lqk 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 11frm• (Adjacent Property Owner Info�ption) 1.
t ure S' nature r*r' v
�1i)+e �1 � (IyroAb%!2 ?4ct4e�,LL
Print or Type Name Sl '
ILI S CnnF, erc t
Date
ne mg earess-y / N U 7
NCB r IQry I (T r!y
Ci�State2ip
< - Hari r.e., ca,'n � � (� ii n./ (- 5 11 1 Ci
/ mail address Telephon Numger/email address
``Y'10e7/r),D
*Valid for one calendar year after signature'
(Revised Aug. 2014)

4/21/2020
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