Fitzgerald, Scott 78840C

®3E^� /CAMA / ❑ DREDGE & FILL V N9 78840 A B 0 D
NERAL 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 �J ,yam,
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / N � �d/� -c
r Rules attached.
Applicant Name S Fitz- �QI Project Location: County / /n__r_ old
Address 1g-1-Z NP'f"I<yYj� Street Address/ State Road/ Lot #(s) �90 A I?
Phone # 6a)M31 / _E-N
Authorized Agent
AffectedNew- AlW -kim
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
ORW: yes /(n91 PNA hey/ no
Type of Project/ Activity
Pier (dock) length--t-P�=r-�
�(/9� //' —OP�
Fixed Platform(s)
Floating Platform(s) l
Finger pier(s)
Groin length
number
Bulkhead/ Mprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp _ n
i
Beach B zin
Other
❑ PTS
❑ UBA ❑ N/A
Shoreline Length 1'3i0- _
SAV: not sure yes A -
Moratorium: n/a yes no �� .
Photos: yes no
Waiver Attached: yes n
A building permit may be required by:
( Note Local Planning jurisdiction
Notes/ Special Conditions
i/ i/ r
PH- z W�
or Applicant Printed Name
gnature ** Please read compliance statement on back of permit**
Appl�n Fee(s) Check #
Subdivision
City ZIP
Phone # (_)T River Basin_
Adj. Wtr.
Closest Mal. Wtr. Body
(Scale: /
❑ See note on back regarding River Basin rules.
I

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: sc a Al 17, Z 92/ 14- rc
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
/V.e,y eloe_"
ro/y si¢-r •/ (3-le•
9i 94/3 6 a s
s� K 6o+t 5-7
Contractor
tic Z8`{6a
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
/bt
necessary for the following proposed development: ` U y" d!Al
sl%2 0 R '✓cam' ,T' A) k�L
at my
in
property located at / l/ 7
d 1141t �2 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 Information: RECEIVED
0
JAN 28 2021
Signature
DCM-MHD CITY
Print or Type Name
Q �c✓n/e/-
Title Cla a
Z o 2-1
Date
This certification is valid through 1 2 / 1 -4- / L _

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 5�C>
Address of Property
2 9 A-lef.
r (Lot or Street #, Street or Road, City & County) Z 8, (( l00
Agent's Name #: �� TQ/ r l� e I (�`
Agent's phone #: 35?2 S3 yb
Mailing Address:
r pc,�
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 roposing. A description or drawing,with dimensions, must be provided with this letter.
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.nccoastalmanagement.net/web/cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified 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 blank below.)
/ I do wish to waive the 15' setback requirement.
✓ I do not wish to waive the 15' setback requirement.
(Pro er y O ner In rmation)
Signature
tf
Print or Type Name
/ ^ice I ►�J1
/t377 /1/Qw
Mailing Address ' A
rUo/,+A g�6r7
City/StatelZip
�z
Telephone Number Email Address
/I -anProperty Owner Information)
Print or Type Name
Mailing Address
ii/17�, ,vL z8q(,0
City/state/Zip
Telephone Number/ Email Address
/ /'L') / Z� 'L I
Dale
Date
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner;
-e-.., A-1 J
Address of Property: �� 1 ! �"' 1C t �►-0 l L� l2� N� Z�
(Lot or Street #, Street or Road, City & County)
Agent's Name #: �✓ !WV e ��,/ Mailing Address:
Agent's phone #:
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.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is beingproposed, 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 athttp://www.nccoastalmanagement.netlweb/cm/staff-listing orbycalling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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.
l/ I do not wish to waive the 15' setback requirement.
(Prope y er Information)
� Signature
<-O t!
Print or Type Name
Mailing Address �J
A/n rH :k fa / b
City/state/Zip
219 - S t%3
Telephone Number/Email Address
t, /22-7 / Z o Z �
Date
�iIV4 "M
Mailing Address
xc,
City/State/Zip
C�/ o 3�� 35'�z
Telephone Number Email Address
27/2;,'Z,T
Date
4�0
(Revised Aug. 2014)

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