Glover, Jack 78972C 148 Laguna Bay Dr.

,CAMA / ❑ DREDGE & FILL 1V 9 78972 A B 1. L❑ D
GENERAL PERMIT Previous permit #
=KNew ❑Modification ❑Complete Reissue El 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 0 7H .1000
)KRul s attached.
Applicant Namel�yy G
Address Z7 ` ` e
City State W IZIC5�0
Phone # (?V '" Q E-Mail
Authorized Agent
Affected ❑ CWEW _qPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes (rio ;' PNA yes J no
Type of Project/ Activity l o
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore---'
max distance offshore _-
Basin, channel
cubic yards i
Boat ramp
Boathouse/ .Oft.) 1 xl7
Beach
Other
Shoreline Length
SAV: not sure yes n
Moratorium: n/a yes
Waiver Attached: no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
or Applicant Printed Name
..A
Project Location: County 0 o S t® LA%
Street Address/ State Road/ Lot #(s)
Subdivision 12
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Body i v man /unkn
Closest Maj. Wtr. Body C — Uf7
l/ i
(Scale: l 10 )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed
S' ature ** Please read compliance statement on back of permit Signat re
k ,
Application Fee(s) Check # Iss ng D e xplr tion Date

GENT AUTHORIZATION FOR CAMA PF.RMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: (.1 I I o � )<► 6 C!
Phone Number: r I t' �' �) (- %SO
Email Address:
I certify that I have authorized E-lin C Mo(ri i) t, r 1 5 L iC b i7
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary for the following proposed development: {� i � ,, Dec t ,)7�
r
at my property located of / 41 --(mi i l l o l� <'u�
County. 1 /
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:
Signature
G we-F
Print or Type Name
Title
O 3 1 —� & 1_ 0
Date
This certification Is valid through
RF—CEIVED
Ap`� 0 1 ZOZO
['ACM -IMHD OTY

I hereby certify that I own property adjacent to
(Name of Property Owner)
properly locates at4L
,,�' ..�...-..r,......A
ram (Address, Iv t, t"Roo,
ad, etoa)
on in
(Waterbody) _ (City/Town and/or County)
The appVtnt has described to me, as shown below, the development proposed at the above
loc
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing devlelopment most fill in description below or aiMch a site drawing)
�6-(f ;�4a c )r\e8
MYAIMER §+ECI1QN
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16' from my area of riparian access unless waived by
me. (if yo ish to waive the setback, you must Initial the appropriate blank below.)
I do wish to waive the 16' setback requirement.
I do not wish to waive the 15' setback requirement.
(Prop rty Oev formation) (Aydj ta!rope bar Infortpationj
,nAli
r r yNv,.r;raury i qq 33 L.
r rur ( ytiu Y�(11f3 /A z
Mail ng . ddr ass j rw A9ai11 III Ild ass
C#y�''j�a� Oi ylStatofZip c
Tele h no Nuirper/email address Telephone Nut ber, ai address
"Valid for one col nd ar .,,oar after signature,
APR 0 12020
WY

I hereby certify that I own property adjacent to Vick � (--7;1 � rs
Name of Property Owner)
property located at rl -¢ (J
(Address, L t, ioc ,Road, et )
on h �U;'�l i In N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Cation.
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 attacha site drawing)
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.
L,► I do not wish to waive the 15' setback requirement.
(Property Ow Information) (>i d "ant Proper wnor: informatlonl.
Sig; ture Sic{► n�plV �1
Maiing, ddr� , ��--
clfy� a etz�
Teleph ne Nulnbor/omali address -
iiaie
"Valid for one calendar year after signature"
Mailing Address
Tac.K�nw7v.� r_ IJ�..
M�;t - �i $i�'( c�P�cks on. eft -Sir -co"
Telephone Number/ email addre s
lcao
Date '
RECEIVE® (Revised Aug. 2014)
APR 0 12020

Project By
Subject Page of
cc Date
� 70 L�9ju� y . �-
/0
APR 0 12020 J
Cad-WND CITY