87882_Mihael Calfee_20221003

fomalt 7CAMA U DREDGE & FILL �� No 87882 A B. C D
GENERAL ERAL PERMIT -.D# A453 Previous permit
Date previous permit issued ' '
•
n New n Modification I I Complete Reissue I I 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 _ n Rules attached. 0 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 I f pTs Adj.Wtr.Body (nat/man/unk)
AEC(s): ❑OEA n IHA n UW n SPIMA n PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity 7z' : . -).-v,,.�.-
(Scale:/"_ ..j
Shoreline Length
Access Length I� IG v' ri'`-1 -4',_.4)-•4‘1a --o- i?i t.,)*I,,
Pier(dock)length 1 - ..-..------ ---�-
Fixed Platform(s) • +i i
FloatingPlatform(s) i
,/ {
Finger pier(s) —_-_ —- 4 __
I
Total Platform area
Groin len gt / I 1 _. I`h# �_ I 1
" {''
Bulkhead/Riprap length
Avg distance offshore ' }i � 1-
Breakwater/Sill - ,4/
ir ri.
Max distance/length '+ 1stox ` ', V
,ciBasin,channel - . l it ,
Cubic yards a
Boat ramp _ �-. r — i_.I —.
Boathouse/Boatlift a'
•til
,. 1. .ui� i „ I
r +
. a
Beach Bulldozing j ,'ICF- 1+
, -:,,,Si_nc IC I.rw0-,.4. I
Other - - I j 1 F-
SAV observed: yes no I I i t y 1 ""
L7r C
yesI r r I
Moratorium: n/a no — = ...._ {••/ { ( 1
l �, �I)
Site Photos: yes no - _
Riparian Waiver Attached: yes no 1 i
A building permit/zoning permit may be required by:
n TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions
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 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: [phone] 252-946-6481
(Serves: Carteret,Craven—south of the Neuse River, Onslow Fax: [phone]
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: [phone]
(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

°4°'`°"�444I iCAMA DREDGE & FILL TZXi No. 87882 ABC D
GENERAL PERMIT --1-145 Previous permit
Date previous permit issued
New I 'Modification I 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:
15A NCAC I I Rules attached. I I 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 CW EW I I PTA I ES n PTS Adj.Wtr.Body (nat/man/unk)
AEC(s): I I OEA I I IHA I I UW I I SPIMA PWS Closest Maj.Wtr.Body
ORW:yes/no PNA:yes/no
Type of Project/Activity
(Scale: )
Shoreline Length
j i
I I I �:
Access Length — _.� __—_r..- !- ( �"_�_t �_ �..... I �— —►sue s. ._._ t •;r,;.1
Pier(dock)length I { j jIA
Fixed Platform(s) j ' ` • it i
a
.. •_ e._ • , Ni,,, ca. . });-,I I �.,
Floating Platform(s) j 4 3 N�wj, _.e,� • l 1 l ,f:,t
Finger pier(s) r j I I I i I
,t i --« '
I
Total Platform area j j
Groin length/# I I ( I �` r , ,
Bulkhead/Riprap length i — -- I- . __,
f'
Avg distance offshore ---- — i — s'
i I
I �
Breakwater/Sill
I I 1 •i
a -.,
Max distance/length ! N 1 . I l S 1�S`\ - T __l
Basin,channel ' , 7Y T I
On 1! l~`'
Cubic yards — j-__ t' I �._.__ __
Boat ramp I ' l r I I 1 h —
Boathouse/Boatlift (
Beach Bulldozing c * }. ,i-. i 46. ? I
Other ' f i _i
. A I i f ( /. ►-
SAV observed: yes no i
I L F , i E. h i
Moratorium: n/a yes no +i+ __ •4, I j } :1 l i ' I 7 �)
Site Photos: yes no I i ! i
Riparian Waiver Attached: yes no i , ' I I _
A building permit/zoning permit may be required by:
TAR/PAM/NEUSE/BUFFER(circle one)
Permit Conditions `
'_ �7 See note on back regarding River Basin rules
lJ 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
t r -- /.7. ..'....—._..
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 Basi 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: [phone] 252-946-6481
(Serves: Carteret, Craven—south of the Neuse River, Onslow Fax: [phone]
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: [phone]
(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
` Governor
MICHAEL S. REGAN
Secretary
Coastal Management BRAXTON DAVIS
ENVIRONMENTAL DUALITY Director
BUFFER AUTHORIZATION CERTIFICATE FOR SHORELINE STABILIZATION
A riparian buffer authorization is required for shoreline stabilization activities within the Neuse and Tar-Pamlico River
basins per Division of Water Resources(DWR) regulations 15A NCAC 028.0233 and 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 compiles 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.
Impacts: Impacts to woody vegetation from clearing and filling in tone 1(begins at the most landward of either
normal water line(NWL)or normal high water line(NHWL)and extends 30 feet landward)shall be minimized to
what must be impacted for the sound installation of the shoreline stabilization project. Unnecessary clearing and
filling in the buffer is a violation of the riparian buffer rules.
2. Clearing& Grading:Clearing and grading of Zone 2 (begins at the landward edge of Zone 1 and extends 20 feet
landward) is allowed provided that it is re-vegetated immediately and Zone 1 is not compromised,which includes
maintaining diffused (non-channelized)flow of storm water runoff through the buffer.
3. Construction Corridors:Construction corridors are allowed for shoreline stabilization projects, but they must be
satisfactorily restored as described in condition 5 below,
a. Potential Overwash: For vertical shoreline stabilization projects(bulkheads)only;sites where wave overwash is
expected to be severe,the first ten (10)feet landward (unless specifically authorized otherwise by DCM)from the
structure may be maintained as a stable lawn in order to provide for structural stability.
s. Temporary Stabilization: Immediately post-construction, bare soils must be stabilized as quickly as possible by
providing a temporary ground cover. Newly seeded areas should be protected with mulch and/or erosion matting.
This ground cover is a temporary measure used to address erosion until site restoration can be accomplished.
s. Site Restoration:At minimum,pre-project site conditions must be re-established.A site that was wooded prior to
this shoreline stabilization project must be restored with woody vegetation eta stern density of 260 sterns per acre.
Non wooded sites may be re-vegetated with woody vegetation. Restoration must be completed by the first
subsequent planting season (November L1 through March 30)after completion of the bulkhead.
Pre-project site conditions: �7 I S /)4j jgkal✓ ea) /N o -
7. Project Drawing:The drawing on the CAMA General Permit is considered the project drawing of your property
indicating the location of the shoreline stabilization structure and any associated clearing, grading,and construction
corridors.This drawing will be used to aid in compliance and monitoring efforts.
By your signature below you agree to be held responsible for meeting all of the abov ste c nditions and that
information is complete and accurate.
Agent or Applicant Printed Name ermrt Offie= $ ignature
�—� 3 - a — 2tz
Agent t want Signature rQ Issue Date
LAMA GENERAL PERMIT 4: V p p O2 53)
Stare of North Carolina I Environmental Quality 1 Coastal Manageinent
Washington Office 1943 Washington Square Man Washington.NC 278891 52-946-6481
Wilmington Office 1127 Cardinal Drive c;.t Millington,Nr o.9405-3845 i 2IO-796.7215
Morehead Cry Office 1400 Connote Avenue Morehead Cry.NC 285Sr ; 52-e08-280a

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)
AA ta IV 1 cnae o %a�-r'rc(a 04(.%s
Name of Property Owner: /�� y� ��/ �(� � / �p
Address of Property: �J 1 g' j I'\t&r�y/-f Gres lea U U ash 1 l (1 1 b n 1 I v (2780 /
Mailing Address of Owner: S U ni Pi (l�s7 (Moro �( •rJ
Owners'email:CMlkee4APeea►@ 90 QrJPhor# (9Sa ' �-I 5' & I �
Agent's Name: Agent Phone#:
Agent's Email:
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.
L/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 t setback, you must sign
the appropriate blank below.)
I DO wish to waive some/all of the 15'setback
c_
Signature of Adja ent Riparian Prope 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:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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.
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 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/core, 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 July 2021

N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM.
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portions tot be completed by
owner�y or their agent).
•Name of Property Owner: M''Set and. 1 to c � -P &
Address of Property: 3'f G ' R i ve\r Acres f d l Washitilnb lit
Mailing Address of Owner: (5 0,-I I��i U.aU p1 8)
Owner's email:m I kte,4Wee,o7(. €c 1Owner'slPhone#: act ' I i 5" (O � l
Agent's Name: Agent Phorie#:
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.
a.
WAIVER SECTION .
('.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 sign
the appropriate blank below.)_
I DO wish to waive some/all,of the"15'setback
- Sig at re 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:
Mailing Address of ARPO:
ARPO's email: ARPO's Phone#:
Date: *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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.
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 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 July 2021

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
I Y1 c C_.el c 0.4
Mailing Address: 3 ` L z, R`v`v t
w A s h..�t� I (V L S
Phone Number 52 9Cc W I
Email Address: � ° ` -24 © 5 wt4,� co v✓'
I certify that I have authorized L
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in 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:
Q
Sign ture Caj+—
'n^ \
tl V't_CNN cA-c5c C
Print or Type Name
Title
11. 0 t 3 19A -2-a
Date
This certification is valid through I I