Ward, Kendall 76315C

AMA / El DREDGE &FILL• 76315 A B �', D
N RAL PERMIT Previous permit # (o�
New odification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by t e State of North Carolina, Department of Environmental Quality %��
and the Coastal Resource ommissiQn in appp areooenvironmental concern pursuant to 15A NCAC
/ ❑ R es attached.
Applicant Name t� c l / �r "� Project Location: County cy
Address Street Address/ State Road/
Lot #(s)
City G G►'e°/.� State ZIP OP / J G� 't --
Phone # ( ) E-Mail Subdivision
Authorized Agent fib `' City /�' T ZIP
Affected ❑ Cw e1l'PTA ❑ ES ❑ PTS ��'�i j3 Z Phone # ( ) River Basin
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body nat man /unkn
❑ PWS:
ORW: yes / no PNA yes / no
Closest Maj. Wtr. Body Cc,
Type of Project/ Activity
(Scale: 1- )
Pier (dock) length _
Fixed Platform(s) I
Floating Platform(s) I
Finger pier(s) i
Groin length
number
I i
Bulkhead/ Riprap length
avg distance offshore
max distance offshore _
Basin, channel --
A building permit may be required by: ��" ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) L Jam,
Notes/ Special Conditions cf /�% J i��c
�oy G
Agent or Applicant Printed Name Permit Offlce s iinted Name
Iic
a � Please read compliance statement on back rit** Sig eV
Fee(s) Check# Issuing ate r lExpiratfon Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1 2w G 1 W a '
A'
Mailing Address: 44C5j i_ar")er Or, Y'-
Phone Number:
Wa��,P- -ores-f- NCB
,273S
Email Address: W ozY'cl
I certify that I have authorized
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:AD
-E-
,- o I
at my property located at 30 1 To Ct t-
in c'V eoe-+ County.
1 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
permit application.
Property Owner Informatio
Signature
/ i W o' 4
Print or Type Name
e- l—
Title
/-)c
Date
This certification is valid through -/,), / � I /
RECEIVED
Ai< 0 ` ,
f12:,
DCM-MHO} CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C9 w s
(Name of Prop rty ner)
property located at o ,] a
_ tt ,, (� (Address,. ot, BI k, oad, etc.
on 91+C� 5&kA--,cam in 42 N.C.
(Waterbody) (City/Tow andlor County)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
9� 7
® d5L
T)Av ; �
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.)
('^ r I do wish to waive the 15' setback requirement.
( do not wish to waive the 15' setback requirement.
(Property Owner In rmati )
Sign Lure
Print or Type Name
Mailin Add s
City/State/Zip
k R- �----
Telephone Number/ email address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Sign�utut•e * .
Print or Type Name
Mailing Address
—ACity/State/Zip
7 C C
Telephone Number/email address
0
- g _ a e -.2 ECEIVE['
Dale*
(Revised Aug. 2014 �,,
MAR 2 -11'

I hereby certify that I own property adjacent to
property located at
�c,cX (Address,
on
(Waterbody)
r;,�r �C� 'a85 1 �-
(City/Town and/or County)
I
The applicant has described to me, as shown below, the development proposed at the above
location.
►/ 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)
'P�-Q ,
m f // V5
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 w' h 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.
SM�"'
� k 0Prit or Type Name ,
City/Statl2ipOk ( G G
Telephone Number/email address
') - a 9-20-2-o
Date
*Valid for one calendar year after signature*
Property Owner lnforma#on)
Print or Type Name
Mai�g Addr s j
City/State/Z*
�s�
Telephone umber / email address
Dale* ---�CE1VE.D
(Revised AWO
DCM-MHD CITY

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