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Home My WebLink About85145B - Harper, Jerry ,e`j PICAMA I I DREDGE & FILL Zr,� N° 85145 A 13 C D GENERAL PERMIT -T.p 44 ° 1 Previous permit Date previous permit issued 0 New n Modification n Complete Reissue n Partial Reissue 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 - n Rules attached. General Permit Rules available at the following link:www.deq.nc.gov/CAMArules Applicant Name Authorized Agent Address Project Location(County): City State ZIP Street Address/State Road/Lot#(s) Phone#(_) Email Subdivision City ZIP Affected n CW n EW n PTA n ES ❑PIS Adj.Wtr.Body (nat/man/unk) AEC(s): n OEA In IHA n UW n SPIMA n PWS Closest Maj.Wtr.Body ORW:yes/no PNA:yes/no Type of Project/Activity (Scale: Shoreline Length • Access Length Pier(dock)length Fixed Platform(s) • Floating Platform(s) Finger pier(s) • Total Platform area Groin length/ft Bulkhead/Riprap length Avg distance offshore - • Breakwater/Sill Max distance/length Basin,channel • Cubic yards Boat ramp Boathouse/Boatlift Beach Bulldozing Other i SAV observed: yes no Moratorium: n/a yes no Site Photos: yes no Riparian Waiver Attached: yes no A building permit/zoning permit may be required by: Permit Conditions n TAR/PAM/NEUSE/BUFFER(circle one) nSee note on back regarding River Basin rules nSee additional notes/conditions on back I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRINTEDt Name Permit Officer's PRINTED Name � Signature"Please read compliance statement on back of permit** Signature Application Fee(s) Check ft/Money Order Issuing Date Expiration Date Statement of Compliance and Consistency This permit is subject to compliance with this application and permit conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s) has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s). The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief, certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: Tar - Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215). Notes/Additional Permit Conditions: Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized project area and disposed of in an appropriate upland location. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889 252-808-2808/1-888-4RCOAST Fax: 252-247-3330 252-946-6481 (Serves: Carteret, Craven—south of the Neuse River,Onslow Fax: 252-948-0478 Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico, Tyrrell and Washington Counties) Elizabeth City District Wilmington District 401 S. Griffin St. Ste. 300 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 Elizabeth City, NC 27909 910-796-7215 252-264-3901 Fax: 910-395-3964 (Serves: Bertie,Camden, Chowan,Currituck, Dare,Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties) Pasquotank and Perquimans Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021 cwk _CAMA DREDGE & FILL 85145 ABCD a -�� ! Previous permit ii GENERAL PERMIT Date previous permit issued n New [ 1 Modification Complete Reissue ; Partial Reissue 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: ISA NCAC Rules attached. — General Permit Rules available at the following link:www.deq.nc.gov/CAMArules Applicant Name Authorized Agent Address Project Location(County): City State ZIP Street Address/State Road/Lot#(s) Phone#( ) Email Subdivision City ZIP Affected n CW EW PTA ES I I PTS Adj.Wtr.Body (nat/man/unk) AEC(s): OEA n IHA UW I 1SPIMA —PWS Closest Maj.Wtr.Body ORW:yes/no PNA:yes/no Type of Project/Activity (Scale: ) Shoreline Length Access Length j ; 1 t l i Pier(dock)length / I P Fixed Platform(s) ,-v" }-r ---- r-r— • Floating Platform(s) _r • I 4 Finger pier(s) j i— I • Total Platform area / i Groin length/# i I I - I 1 • Bulkhead/Riprap length --- •- }-4 •y.--. - — — . Avg distance offshore I - I Breakwater/Sill ' Max distance/length I ice. Basin,channel — Cubic yards —1-- -r — . Boat ramp i i i Boathouse/Boatlift ; Beach Bulldozing • r i Other • E i JVA",. ; t I - t i I s, - ,"✓ SAVobserved: yes no -t- 1 .7..___"--44-..4.._ ....._. •.. ____,_._. e , S • -.,. _ .. ..., l Moratorium: n/a yes no i ` � i 1 ' Site Photos: yes no 1�-- ---T--__.- --. - - - _ Riparian Waiver Attached: yes no A building permit/zoning permit may be required by: TAR/PAM/NEUSE/BUFFER(circle one) Permit Conditions See note on back regarding River Basin rules II See additional notes/conditions on back I AM AWARE OF STATUTES,CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) Agent or Applicant PRINTED Name Permit Officer's PRINTED Name Signature**Please read compliance statement on back of permit** Signature Application Fee(s) Check#/Money Order Issuing Date Expiration Date Statement of Compliance and Consistency This permit is subject to compliance with this application and permit conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s) has been obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s). The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief, certify that this project is consistent with the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: Tar- Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Resources. If you have any questions, please contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215). Notes/Additional Permit Conditions: Please ensure all debris associated with the removal or construction of the permitted development is contained within the authorized project area and disposed of in an appropriate upland location. Division of Coastal Management Offices Morehead City Headquarters Washington District 400 Commerce Ave Morehead City, NC 28557 943 Washington Square Mall Washington, NC 27889 252-808-2808/1-888-4RCOAST Fax: 252-247-3330 252-946-6481 (Serves: Carteret,Craven—south of the Neuse River, Onslow Fax: 252-948-0478 Counties) (Serves: Beaufort,Craven—north of the Neuse River, Hyde, Pamlico, Tyrrell and Washington Counties) Elizabeth City District Wilmington District 401 S.Griffin St. Ste.300 127 Cardinal Drive Ext.Wilmington, NC 28405-3845 Elizabeth City, NC 27909 910-796-7215 252-264-3901 Fax: 910-395-3964 (Serves: Bertie,Camden, Chowan, Currituck, Dare, Gates, Hertford, (Serves: Brunswick, New Hanover and Pender Counties) Pasquotank and Perquimans Counties) http://portal.ncdenr.org/web/cm/dcm-home Revised 6/01/2021 ROY COOPER $ty< Governor MICHAEL S. REGAN Secretary Coastal Management BRAXTON DAVIS ENwRONtleNTAL QUALM D(rgdur BUFFER AUTHORIZATION CERTIFICATE FOR PIER AND DOCKING FACILITIES ACCESS WAY A riparian buffer authorization is required for pier and docking facilities access ways through the Tar-Pamlico& Neuse River Riparian buffer per Division of Water Resources (DWR) regulations 15A NCAC 02B.0233 &.0259.The Division of Coastal Management(DCM),through a Memorandum of Understanding with the Division of Water • Resources (DWR) has reviewed your project proposal and has determined that the project as proposed complies with the aforementioned regulations. Those activities covered by your Coastal Area Management Act(CAMA)permit have received Buffer Authorization • provided the project is constructed in a manner that continues to meet all of the conditions listed below.Failure to comply with this Buffer Authorization may subject the property owner and the party(contractor)performing the • construction and/or land clearing to a civil penalty by DWR of up to$25,000 per day per violation. • 1. Crossing is Perpendicular: Pier and docking facility access way must cross the 50 ft.riparian buffer perpendicularly(which is defined as between 75 and 105 degrees)unless otherwise approved by DCM.The alignment shall minimize the removal of woody vegetation to the greatest extent practicable. 2. Pervious Materials:All reasonable measures shall be taken to ensure the access way is made of pervious materials like open-slatted wood or composite,mulch, or grass to meet the intent of the rules to the maximum extent practicable. 3. Access Width:The width of the pier or docking facility access way shall be limited to six(6)feet. 4. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your property indicating the relative location of the pier or docking facility and any requested access way.This drawing will be used to aid in compliance and monitoring efforts. //))// • Pre-project site conditions: rt.,e,q�,' cd 4wii — eeei/f Ic/%L«f i—YtA2 rip- 2,-7 By your signature below you agree to be held responsible for meeting all of the conditions listed above and verify that all information provided is complete and accurate. S erY/ 171/51730t • Agent or Applicant Printed Name Permit Officers Signature • Ag t or A licant Signature lss a Date CAMA GENERAL PERMIT#: t3 -SI VX" State of North Carolina I flrvhonmental Quality f Coastandanagement • WashfngtonOffice 1943-Washington Square Mall Washington NC 27889 1252-946-6481 • Wilmington Office 1127 CardInaI Drive En.w&nfngtan NC284435-3845 1910796/715 Morehead City Office 1400Commerce Avenue Morehead City.NC 28557 1252-808 2808 3-29-22 Hi Shane, it was nice meeting you the other day. Here are the permits to repair existing boat ramp if possible. Placement of mooring ball out in front of our property no further than 400ft, drive new dock pillions each side of my existing dock and extend the dock approx. 100ft, The dock used to be 188ft a couple years ago there are still pillions from existing dock under the water that I will have to take out. The dock will be no further out than the docks left and right of me. Plus two additional posts on my side of the property for a 4 way tie. I realize we need a different permit for dredging of boat ramp and next to dock, Robbie has yet come down with a boat to measure the depth of water out from the boat ramp, but a week or so ago when we had a real low tide I put my rubber boots on and was able to walk out to 188ft in line of the dock to the right of me that is that long or longer and there was about 18" of water and the river was down at least 2ft so there's about 3-1/2ft plus of water out that far during normal tide. don't remember how far you said I could go out to find the depth of water to see if it could be dredged that deep back to the shoreline. Please let me know how much the permits are going to run. Thank you, /1 ad ticcw• � l/� ��.�� Jerry Harper �� ic s 325 Clark Rd Bath, NC 27808 603-455-5660 • N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner: J .Xx' AACif per Address of Property: p\a UCH PVC, c n Mailing Address of Owner: ar- C* ('t' 9 Owner's email: -C1YlO�er—kl4y0 Owner's Phone#: LOD 3 Li5-5-J`-&49° VV CJ Agent's Name:ROb )bp K n5 Agent Phone#: 05_ _9(014-3 ya(p Agent's Email: ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adiacent Property Owner) 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 descriptio or drawing, with dimensions, must be provided with this letter. _ ,/�/ I DO NOT have objections to this proposal. I DO have objections to this proposal. if you have objections to what is being proposed, you must notify the N.C. Division of Coastal Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be contacted at(252) 946-6481. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that any proposed 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 (this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must scan the appropriate blank below.) - I DO wish to waive some/all of the 15' setback _ _ --- Signature of Adjacent Riparian Property Owner -OR- I do not wish to waive the 15' setback requirement(initial the blank) Signature of Adjacent Riparian Property Owner: Typed/Printed name of ARPO: a/ A D/ lam/ /L,r- W-) ' Mailing Address of ARPO: L :� Q ( i�! � / /CW ARPO's email: V in 6-lei ( ce u ARPO's Phone#: S- 4 L V 2 S /y Date: 0.3/)y/ Z, *waiver is valid for up to one year from ARPO's Signature* Revised May 2021 46 ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to ' Je-( , l ` f 's (Name of Property Owner) property located at 3 J C\Ct r G\ (Address, Lot, Block, Road, etc.) on v`A.0 Sven 6 , in C. , N.C. (Waterbody) (City/Town and/or County) The applicant has described to me, as shown below, the development proposed at the above loc;iek 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) • - cv\cloc kx x\\ Al 1Dr 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 Owner I formation) (Ad'acent Property Owner Information) S attire Si attire* `)( t\c rJORA toF. Lf) r? Print or� a Name Print or Type Name f C 10,( r d '3 3 n Clark led Mailing Address Mailing Address it /State/Zip City/State/Zip i0 b -u35 s lo(co Ali r. Telephone Number/email address Telephone Number/email address 3-ow -a ca a q 6 V a s/ ` Date Date •*Voindet /a4/& Snd9 (Revised Aug. 2014) *Valid for one calendar year after signature* - . ♦ TIPS FOR ADJACENT RIPARIAN OWNER NOTIFICATION &WAIVER FORMS CAMA Regulations require notice of proposed development to the Adjacent Riparian Property Owners(15A NCAC 7J.0204(b)(5)). Proof of actual notice (a sign-off by the owner on this form) or certified mail return receipts(showing delivery of notice)are needed, or any other method which satisfies the Local Permit Officer (LPO) that a good faith effort has been made to provide notice. The purpose of this notice is to make adjacent riparian property owners aware of the proposed development so that they have an opportunity to provide comments (or potentially object to) the proposed development, and to give DCM or the LPO an opportunity to consider these comments/objections before a permit decision is made. "Permission" of adjacent property owners is not necessarily required for DCM to issue a permit; however. permission must be obtained for certain types of proposed developments if they fall within a 15' setback area along the riparian access area of the adjacent property, as determined solely by DCM. It is in the applicant's best interest to provide comprehensive and accurate notice so that any concerns or objections can be resolved early in the permit review process. In addition, if the adjacent riparian property owner appeals the permit decision, insufficient notice could be a basis for granting such an appeal. Who is an Adjacent Riparian Property Owner? What is Adjacent? (Note: DCM reads this broadly to ensure comment by potentially impacted neighbors) • A property that shares a boundary line with the site of proposed development; AND • A property that fronts a natural or manmade waterbody that is connected to coastal waters and can support some form of navigation, even a kayak or canoe, including a common canal system or a manmade basin. • Easement holders? Yes. if the easement could be impacted by the proposed development. • Streets/Roads? Only if the street/road could be impacted by the proposed development. This might include street-ends which might be used for parking and beach access. • Holders of recognized submerged lands claims/shellfish franchises. What is Riparian? Do the boundaries of the adjacent property legally intersect with the water at mean high tide? If there is a question about whether an adjacent property is considered "riparian," please reach out to DCM Staff - especially on the oceanfront beach where there may be undeveloped parcels on the beach or in the water. Who/What is a Property Owner? For private individuals(or families), send notice to the address listed on the tax card. If the property is owned by an Inc. or LLC, please send notice to the person listed as the registered agent on the NC Secretary of State's Corporations Look Up site: https://www.sosnc.gov/search/index/corp. For Condominiums or neighborhoods with an owners' association (HOA/POA), send notice to the association (which is usually a corporation, for which you send notice to its registered agent). What is Notice, and how do I ensure it is received? • You can meet with your adjacent property owner, provide a description or drawing of the proposed development, and ask them to sign this form and return it to DCM; OR • You can hand-deliver this form and a description or drawing, and ask your neighbor to return it to DCM (consider providing them with a stamped envelope); OR • You can mail this form by USPS Certified Mail, return receipt requested (the Green Card). If you choose this option, you must provide either the signed & returned green card OR track the certified mail package number on USPS.GOV's online tracking system, and provide the tracking print-out as proof of delivery to DCM If you have any questions about this process, please reach out to DCM Staff and DCM Legal Counsel and we will work to answer your questions. Revised May 2021 N.C. DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM CERTIFIED MAIL RETURN RECEIPT REQUESTED or HAND DELIVERY (Top portion to be completed by owner or their agent) Name of Property Owner'. lt�1c r` \ '1 ` -t Y �t Address of Property. a • \ -t 6 KCk 1 fit'\-v )�- aI v-0.1- Mailing Address of Owner. '35 C\Q-+f [1 0 L 1.�C\* NC a S0`, Owner's email/YO(0 t Sitr5rACCiI.(owner's Phone#: CD Oa Y rS /vt°0 Agent's Name:I?OU H)I645 Agent Phone*: a 5)--9Yq-�f35L0 Agent's Email! 1 ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION (Bottom portion to be completed by the Adjacent Property Owner) 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 DO NOT have objections to this proposal. I DO have objections to this proposal. If you have objections to what is being proposed, you must notify the N.C. Division of Coastal Management(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 943 Washington Square Mall, Washington, NC 27889. DCM representatives can also be contacted at(252) 946-6481. No response is considered the same as no objection if you have been notified by Certified Mail. WAIVER SECTION I understand that any proposed pier, dock, mooring pilings, boat ramp, breakwater,boathouse, lift, or groin must be set back a minimum distance of 15'from my area of nparian access unless waived by me (this does not apply to bulkheads or riprap revetments). (If you wish to waive the setback, you must sign the appropriate blank below.) I DO wish to waive some/all of the 15'setback 72/7 �� ,'r`` C L L Signature of Adjacent Riparian P►opedy Owner -OR- 1 do not wish to waive the 15' setback requirement (initial the blank) Signature of Adjacent Riparian Property Owner: (14'.C P �� A•e Typed/Printed name of ARPO:1-:\1_1C(' OCR_' Mailing Address of ARPO: Cl .\. (. \ a( AN )(>L t' tit? ARPO's email: ' itiE. n (, ARPO's Phonon:CM -"&//' T5 Date: ..5 _6724, _' ?_ waiver is valid for up to one year from ARPO's Signature' Revised May 2021 Mail Mali IVHASe-l./uuook 5/2J22, 11-46 AM N.0 DIVISION OF COASTAL MANAGEMENT ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM CERTIFJDMAIL RLr URN.I?LC,EIt't rat ciUL0111)..t)r..iAf4P_D.ELIY. R1. (Top portion to be completed by owner or their Agent) Name or Property Ownerc,4 1\� All c)('_C .. Address of Property` )___S ,G-,r 1S `A 123(gy :]Yl t`w.1 c DIA LACYLACYS Mailing Address of Owner? —' ( J �� +LpK'I 1 PI ^ tY`` t i &I1 Owner s email. ftviak._L.1M h"r'W".%Pt.y ii _4 I ..j k.'�iS,''u 10 t,pt� `�r�r' C1�3tL1S�s` Agents Narne:.j ji1 C.._�v. 'l't t"�. Aueni Phvnr.N : y ,.) -C;VUII"-‘,"i35 Agent's Email. — —_ ._._ ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION tBgttom Portion to be completed by the Adjacent Property Owner) 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 procosirx_ A deey• t or drawing.+Faith dimensions.must be provided with this letter. I DO NOT have obdions to this proposal. I DO have objections to this procr�sa ff you have objections to what is being proposed, you must notify the N.C. Division of Coastal Management(DCM)in writing within 10 days of receipt of this notice. Correspondence should 04 mailed to 943 Washington Square Malls Washington, NC 27889. DCM representatives can also '..e contacted at(252) 946-6481.No response is considered the same as no objection if you have beer notified by Certified Mail. WAIVER SECTION I understand that any proposed pier,dock, mooring pilings,boat ramp,breakwater, boathouse,Vt, cc groin must be set back a minimum distance of 15'from my area of riparian access unless waived by me (tfis does not apply to bulkheads or riprap revetments).(if you wish to waive the setback.you must sign the appcopnate blank below.) ^-4 I DO wish to waive some/all of the 15'setback Signature of Adjaceo. Riparian Property Owner -OR i do not wish to waive the 15' setback requirement(initial the blank) Signature of Adjacent Riparian Property Owner:Typed/Printed name of ARPO: Mo_ e 1-''r t'3 - � Mailing Address of ARPO: l � :- Y�tI � Q vc t-\ A..4'V .-Si t- E- tare'E 'N.J.,\\e o C_ ma++e,neci..3epe <"OntwI.con ARPO's Phone*: ��l �" �'t1 1 5.E ARPO's email: Date; .SAL --1L *waiver is valid for up to one year from ARPO's Signature' Revised May 2021 , ..__.,,.....1_,1..,rfi,-a1FS rnmrmaiirmhrodiriiAAnkADM3ZiYONINht_TkxNTItNGMxYSO4NZR)LTBjMDE4NmRIMG.IjNwAQANIbicvwZRxlndRvgmgMwIW AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION 42 Name of Property Owner Requesting Permit: _I L e el° T 1 -n V Mailing Address: .3&3 C ) c- i K I?Ci xt.+-G 1 1J1C 37s-Ds Phone Number: 0 -. _ L/5..5 Streo CD Email Address: b%o.- i 17t (Q`7i ! kli2 '. C&Jt' - I certify that I have authorized g'ibbie:, . -Ha .c‹ 1 S- ._��..__, Agent/Contractor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: (-6Q1 ✓ E'.y 1 Sf 7r-i. (60 _ c 7L b°L , J}- A d oI- 'v9 /3,92z 6oc.¢7c;'/41 at my property located at `Yl GI 0 P c/ete-K le(' _._. Y in ie County. VA et' 1' OR 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 connectio with evaluating i ormation related to this permit application. A'' , 44:1 MIDP Ft _ Property Owner Information: !/ t7/1147114 444.- miii# 0.<:, )<:, 4,01 S nature x M,¢L co`HI .i-1402 Print or Type Name 4 4 0 Aft ..,.i7 z.•..v� D 49Nd1� Title Date CALL. yy��e ( GvL iv, i f' 'it i ,9vP��/ Qv silks- ge 59%, yd �/ This certification is valid through / I . .