Atherton, John 78823C

-6CAMA / ❑ DREDGE & FILL J 8823 A B D
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �Iy �7 ,..
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC W . /2( 'i
J /' Rules attached.
Applicant Name
n� FJ11tj(���fi/) Project Location: County (�(l��il
Address 'f.'lJ t '� `v Street Address/ State Road/ Lot #(s)
City StateW, ZIP
Phone # 44q)E-Mail
Authorized Agent
E3 CW
—AtEW
.-aPTA El ES ❑ PTS
Affected
A
❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ WA
Affecte
❑ PWs:
ORW: yes y "O­)
PNA
ye no
Type of Project/ Activity
Subdivision —
City ZIP__
Phone # ( _) River Basin
Adj. Wtr. Body / Y^,� /�\'� hat
Closest Maj. Wtr. Body�4N�a
' (Scale:
Pier (dock) length ___ .... - ._. __. _ __.__.
Fixed Platform(s)
Floating Platform(s) fig
Finger pier(s)_ ✓ ..i1/'
Groin length - i- -- - -
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore _ Q\uCL� - ..�0 I.
Basin,
cubic yards
Boat ramp
Boathous oadi(t
Beach Bul dozing• -
Other
r
Y -
Shoreline Length N E(
SAV: notsure yesis
Moratorium: Na yes
Photos: yes no
Waiver Attached: yes ----
A building permit may be required by: LX.�_Ce, (A•
( Note Local Planning Jurisdiction) pf
Notes/ Special Conditions'—hU (CXCr'r;J loot
rn CzrOMtn U
n ftg't or Applicant Pinted Name
Si azure #° Please read compli ce statement on back of permit
&20
Application Feels) Check #
❑ See note on back regar
_f..__ n
Printed
River Basin rules.
Date

G
NICAMA / ❑ DREDGE & FILL V NO 78823 A B 0 D
L�JGENERAL PERMIT Previous permit#
New [-]Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality m�
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC W7
�'� —� /� Rules attached.
Applicant Name —: 'bl'1 q j� jVT I nA Project Location: County rsayy)
Address . &� 1 pW&1/ AJrl (12 Street Address/ State Road/ Lot #(s) S_ �
Phone #
Authorized
State ZI PA�J_�,?j�
E-Mail
AAffected71 CW -�EW .O'PTA V LIES ❑PTs
Affecte ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes Co)
no PNA
Type of Project/ Activity _
Subdivision
City ZIP���
Phone # (_) River Basin (V @I��,
Adj. Wtr. Body 0 nat man unkn
Closest Maj. Wtr. Body
Pier (dock) length
Fixed Platform(s) FF
Floating Platform(s) T �(
Finger pier(s) .�
Groin length /' _..._. -� 1
number
Bulkhead/ %prap length �' I __- - t•` i__
avg distance offshore
max distance offshore'
Basin,
cubic
Boathous� Boatlift��S %c /✓
Beach Bul o ing
Other S i
r
i
Shoreline Length 7yes
SAV: not sMoratorium: Photos: Waiver Attached:
A building permit may be required by:
( Note Local Planning jurisdiction
Notes/ Special Conditions
:rCEbrtaA„u 5
ftoKt or Applicant Printed Name -
Si cure ** Please read compliance statement on backofpermit**
CIO
Application Fee(s) Check #
(Scale: / , Io / )
❑Y
See note on back regarcling River Basin rules.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT - r
I hereby certify that I own property adjacent to �ml-[A[ uV ��70`V 's
N me of Property Owner)
property located at LVT 2/ (QbPI TD �//V�72 ,; IJ4i4o � /VC Z &6
�i (Address, Lot Block, Road, etc.)
on /���/ns ��E "� in Wy-ii- +K 'N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Inrati n __. os__
q 1 have no objection to this propal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in descnpf n below or attach a site drawing)
WIN,Xt AIn'd
New ter—7 a ®r ,kw � Ooe4l- TAV-1101"
�t
lz� 1571&6 tooE(�
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.
wish to waive the 15' setback requirement.
Print or Type Name
*Valid for one calendar year after signature*
Owner Information)
PrOforType Name
Mailin Address
1f,4�ezoC°K,
Cit /State/Zi
Telephone Number/email addms
Dale*
--66io
RECEIVED
Aug.
iAp!1 � 7 2021
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to lPll 1-nega/q m6t- 146's
(N me of Property Owner)
property located at /�17-v2/ &00 J-(OY/u� lx
------ W
on�iE}/Yl� infh% ----
C�I/�71i CID!% T, N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
_lo to iqn.. _.. ---- -- ---- _
�_ 1 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)
A rotnput
4-1
a eI I
New Ltd .�, d i �i�/1/�r.w out/t Yd�-TA.uSrev
N�
I
ry-157[ vG n �e '
HCIA �f1n/�hP7�
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.)
rn
Date
I do wish to waive the 15' setback requirement.
I do p_ot wish to waive the 15' setback requirement.
a, e, ;-5
—,�jY3
ler / email address
Owner Information)
l&E
/email address
hadMf
0
*Valid for one calendar year after signature'
(Revised Aug. 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �oNL /'Em % o er tw
Mailing Address:
Phone Number:
f ffA5za cY, , l� Cr _
;7_6�L - '-/z-N- as q3
Email Address: 1�ry, r4ntf-AroA1 "96-MAF09 2/:Y' WM
I certify that I have authorized r6m l�(11eC /�qqeg �' i' ��� S�y� % F(K
7166vo2��HAY �tr t/�7QRI�C9/�7a�Lo (��OIYJ
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: O&eV- 147,0,vsiow "' L( P7-�
at m/y� property located at [aC`X�
in (, P_RI/C='7l% County.
I furthermore certify that 1 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
Print or Type Name
�RDPL Tz/ D t 6y'
Title
la. , a 9 , a.oao
Date
This certification is valid through q I ) I .1-/