Prevo, Mike 78836C

AMA / 11 DREDGE &FILL N9 78836 A B 0 D
GENERAL PERMIT Previous permit#
Mrolew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC���d��
Rules attached.
Applicant Name �1����F m Project Location: County
Addressi��)V_A��l Va Street Address/ State Road/ Lot #(s) �1-
Phone # (LD ) Laj­f)&� E-Mall
Authorized Agent _—�__�t� �
Affected C CW -*W PTA ❑ ES ❑ PTS
): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(
❑ PWS:
ORW��/ no PNA �/ no
PNA �/ no
Type of Project/ Activity
Pier(dock) length =_
Fixed Platform(s) ___...
Floating Platform(s)
Finger pler(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore •'
Basin, channel
cubic yards___
Boat ramp l✓ .—
Boathouse/ oatliR
BeachBull
Other
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions _ll
or
Si aturg�**PleAse read compliance statement on back of permit**
K�uvm')/Wt
Subdivision
CityZIP
Phone# (_) River Basin
Adj. Wtr. Body . ' na unkn
Closest Maj. Wtr. Body
.. t". /_.1 "s
I
❑ See note on back regarding River Basin rules.
Fee(s) Check#

p L
CAMA / ❑ DREDGE & FILL NO 78836 A B 0 D
GENERAL 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 ) )
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC f p20./
q Rules attached.
Applicant Name M I k/fP�_ `gYV�i�Dnn Project Location: County (9 J (,q41
Address j 1/ V 4PaV 1 1 VP_ Street Address/ State Road/ Lot #(s)
Authorized Agent T
ptpt I RCo )i .S.
Affected LlCW 'mil -�W A D❑ ES PTS
❑OEA ❑HHF ❑IH fIUBA ❑N/A
AEC(s):
❑ PWS:
CRW: yes / no PNA ye / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pler(s)
Groin length _
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel .i
cubic yards
v
Beach BuIlrZing�
Other II// I1II
Shoreline Length._
SAV: not sure yes
Moratorium: n/a yes I no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions --
1S A CAS lJt �
t or Applicant Printed Vkme
Si ature **Ple a read compliance statement on back of permit ** *i_a r, � �
Application Fee(s) Check #
Subdivision
City ZIP
Phone# (_) R4verBasin
�
Adj. Wtr. Body na unkn
Closest Maj. Wtr. Body
(Scale:
❑ See note on back regarding River Basin rules.
n
Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ;.All p o
Mailing Address: 'j 1 Queer V\j � iiY
Phone Number:
l(
my
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: YCat ,It
at my property located at
in 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:
i�' �E'Z'
Signature
0"-1(-1-5 M . �eXfh
Print or Type Name
Title
I 1
Date
This certification is valid through !
RECEI E't'.
JAN 2 0 2021
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. , n NlcC lead 21(?\0
Address of Property:
(Lot or Street #, Street or Rdad, City & County)
Agent's Name#. a h 0a.ber Mailing Address: 1?)'3 \'JjrCAfflIU Lh-
Agent's phone #: I�(�- ,�(�- �j'I \QC j T PI'YI,I
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.
a 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
(DCM) In writing within 10 days of receipt of this notice. Contact Information for DCM offices is
available at http://www. nccoastalmanaaement net/web/cm/staff-listing orby calling 1-888-4RCOAST.
No response Is considered the same as no oblection If you have been notified by Certified Mall -
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.
I do not wish to waive the 15' setback requirement.
(Property Owner Infgrgiation)
Si lure ���/)
Print or Type Name
3\`1 1AarVV �r
Mailing Address
Sa zAss rn t NC Liir�
City/State/Zip 1.1—
q n - 5�3 _I_ -Mo0
Telephone Number/Email Address
113Dale
(Riparian Property Owner Information)
Sir"lure /
Sa s h i _ A� L t�
Print or Type Name
3 16 Ai; "r /1 VE
Mailing Address
cld C',ry A 2-
City/State/zip
X,?.3 - 6 z ,Y
Telephone Number/Email Address
2-2z-7
--
Date
_--------------- ----
(Revised Aug. 2014)

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONNVAIVER FORM
Name of Property Owner: ) Ames K\�O ea. he,\10 _
Address of Property:
IN
(Lot or Street #, Street or Rbad, City & County)
Agent's Name#. M�ailingAddress:: V�6 Vlrllr%Lh
Agent's phone #: `�IU 33(�- S�LL�3 >1 e0A i -em me 29:160
I/
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.
J 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
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices Is
available at h[tp://www. nccoastalmanaaemenf.not/wab/em/staff fisting or by calling 1-8884RCOAST.
No response Is considered the some as no objection If Lilo have been notifled 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 blan b to )
ak 4— - d
1 do wish to waive the 15' setback requirement. ((qj, D /
(U� I do not wish to waive the 15' setback requirement.
(Proper Owner I fgrgration)
Si lure
Jc-.my�3 tl
Print or Type Name
Mailing Address
S)ST-(xr\A w-
City/state2ip 1.1
G 10- 581-02,(o0
Telephone Number/Email Address
II ail
Date
(Riparian Property wrier Information)
Signature/ W L
etiyr- {.4w1-5'
Print or Type Name
Mailing Add ss
City/state2ip
q10- F -4?a L.sm�la/,fv
Telephone Number/Email Address `t/1 A&
/,_-- i- �0
Date
(Revised Aug. 2014)