Costanzo, Chris 78806C

CFE
/ ❑DREDGE &FILL ���/
GRAL PERMIT
NModification ❑Complete Reissue El Partial Reissue
9 7880
A B
Previous permit #
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"Ilk I 'f s ��►�✓
RSRules attached.
Applicant Name 1 rJ (�c7 I ah70 Project Location: County OrJ5 / O 1W
Address r�- �Z�W�- ,ykl —'Y D� 1 VC�i Street Address/ State Road/ Lot #(s) �
city -Z
fieAA
Phone # IQ)
Authorized Agent1�n��,,n,�
Affected ❑ CW �'p-rAS ❑ PTS
AK(s): ElOEA ❑ HHF ElIH ❑ UBA ❑ N/A
❑ PWS:
fal _5 --F�%d
t or Applicant Printed Name
Sig ture ** Please read compliance statement on back of permit
Application Fee(s) Check #
Subdivision
City ZIP
Phone # ( ) River Basin kk;��
Adj. Wtr. Body r� (�w V (nat /unkn)
&A - C
Permit Officer's Printed Name
IJ
Signature
11
Isstl ng Dfate Exp' ation Date

Name of Property Owner Requesting Permit: o
Mailing Address:
Phone Number:
Email Address: CbL e 61 cl
I certify that I have authorized
Agent / Conti -actor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development, r 2i e
Lei C
at my property located at _.0
in S County.
/ 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.
Print or Type Name
L On e r
Title RECEIVED
? 2-6
Date NOV 0 3 2020
DCM-MHD CITY
This certification i- valid through _ 1-/

t
J 9,3 tv4Jry bU*Y Dr- ,
�- - '75
.. RECEIVED
o 0 3 2020
DCM-MHD CITY
D!

ADJACENT -Hjf!AtIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to y 15 0 Ln4zA n �',o °s
i IV -.
me of Property Owner)
property located at '� t�;at
(Address, Lot, lock, I oad etc.)
on ' , �n �
(Wlaterbody) (City/Town and/of County)
The applicant has described to me, as shown below, the development proposed at the above
1 do
i have no objection to this proposal.
I'l1�
fi4 i have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must flit in de4r6ription below or attacha site drawing)
)8 AIVER 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 I ormation) (Adjacent
%%Prop" Owner information)
Si tare, Sign ture *
Pri t r pe N rn Print or Type N arqe
r
M� ling Addr ss Ma�r�g JAddr ss
G+¢VL t te/Zip City/3 ate2ip 7 ""
Telepng Number / email address Telephone yumber / email address
-0� ,
Date RF-CO) � ---
Date"
*Valid for one calendar year after sigwio 3 2020 (Revised Aug. 2014)
DCM-MHD CITY

A An
R �
I hereby certify that I own property adjaZl',
o
Prof ty located at 1 "of Property 13wn,.�
on (Address
(ctty!'t'awn andl+ C�untyj
The applicant has described
i° to m�a, as shown below, the development
1
i have no objection to this Proposal. proposed at the above
E1 G ------- - i have objections to this
Proposal,
z wgp
pron AND/OR ORAwiNG OF PRQPpIDEYELpPM ENT
(fndJvtdu�rl posing devetoPment must fill /rt descrlpf�o» EDbelow or at%ctr s site
drawing)
I understand that a pier, dock, mooring must be set back a minimum distance f ��1$, boat ram
me. (If you wish to waive the setback, you moat Initial p' breakwater, boathouse;, lift, or groin
trt�m my area of riparian access unless waived by
the appropriate blank below.)
l
r� I do wish to waive the 15' setback r
equirement.
i do not wish to waive the 15' setback requirement.
(Property O atlon)
{Acl)ac$nt Prope,Ky Owner Informatlorr)
Sf ture,
r .Clan,
N A`
I A
Telephone N m CitylState/Zip� g if, ►�
,�M ! bsr / email 8ddrpSs'C� Q
Dare M T Rhtine Afurnherl
-Valid tear vn® calendar year a signatureI VE D
9nature (Revised Aug. 2014)
NOV 0 3 2020
DCM-MHD CITY