Rogers, Bruce 76349C

^ cAMA /REDGE & FILL No. 76349 A B D
ENE L PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �, !y
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC a
ules attac d.
Applicant I�e Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
.,.ram
Phone #gWCA1,
l I 7-V4/
E-Mail
Subdi ' ion
Authorized Agent
City
Affected w
�Bw PTA AS ❑ PTS
honV#�
AEC(s): OEA
❑ HHF ❑ IH ❑ UBA [I NIA
Adj. Wtr. Body_
❑ PWS:
ORW: es no
PNA yes /
Closest Maj. Wtr.
Type of Project/ Activity
Pier (dock)length
Fixed Platform(s)1 xx
Finger pier(s)-'1 Xil'
Groin length
max distance offshoreQ
Basin, channel
cubic yards �---
Boat ramp
Boathouse/ oat i(
Beach Bulldozing
Other_
Shoreline Length
SAV: not s7yes
Moratorium: Photos: Waiver Attached:
A building permit may be required by:
( Note Local Planningjurisdiction)'\
t
Sig ture **Please read compliance staterneintlon back of per /*J*
Application Fee(s) 6 Check#
❑ $ee note on back
Ul.
(Scale: j
River Basin rules.

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: corn, Rnn ec5
Mailing Address: R Pao o"SS<
Phone Number: 2.52- 9N h t-1Z71
Email Address: r CC e P.C. «. Ca✓✓l�
I certify that I have authorized itu5AiV, ('_Iaua. / Pe7> Ca-1r, A
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1/;"/ 1 lj�t � d'
at my property located at 17-7 1,
in c County.
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 Info mon:
l
n8tUre
IJcue.0 Ira cC5
P11nt or�ype Name
OWnoC
Title
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ro n Rccecs 's
(Name of Property Owner)
property located at 127 _ Po' A 9I vo)k
(Address, Lot, Block, Road, eta.)
on Deer Cc-eek in Cape. P_d.r4, e N.C.
(Watarbody) (Clty/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatloP.
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)
See A-4,,� eJ,A-
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 y u wish to waive the setback, you must Initial the appropriate blank below.)
1 do wish to waive the 16 setback requirement.
I do not wan to waive the 15' setback requirement.
cily)stata2ip
252-21i1- 92.71
Telephone flumoer/emaff address
3110)Zt) /2
Date
Date -
Property Owner Information)
(Revised Aug. 2014)
"Valid for one calendar year after signature'

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Bcurp— RQZFCS 's
(Name o'f Property Owner)
Property located at 12_ ('gam
on �%ec cee�C (Address, Lot, Block, Road, etc.) 1
C , In Co,e i.rr�t.�o-! . N.C.
(Waterbody) (City/town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must flit In description below or attach a site drawing)
See A-4a,l , -V
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 Oy�ne"formation) (Adjacent Pi
Date•
(RavisedAug. 2014)
'Valid for one calendar year after signature'

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