Spencer, Lennie 84227C

d(W—W L1dCAMA ❑ DREDGE & FILL NO 8 %�% A B� p
Previous permit
ENERAL PERMIT
Date previous permit Issued
New ❑Modification El Complete Reissue ❑ Partial Reissue
As authorized by the State of1North
fCarolina, Department of Environmental Quality and the Co Resources Commission in an area of erwironmenul concern pursuant to:
15A NCAC 0-1 T 1 . 1 I VlJ ❑ Rules atuchad. General Permit Rules available at the fc ing link: www.dea.rx: g&/CAt2Mles
Applicant
City
Phone M
Email /
Authorized Agent
Prolect Location (County)•
Street Address(Sy to R d/ t (s)
Subdivisionl��- r
City ZIP ZIP
Affected �V ®LPG tgin Be ❑ pTS Adj. Wv. Body /&,—" na unk)
AEC(s): ❑OPA ❑IHA ❑UW SPIMA ❑PWS Closest Mal. Wtr. Body_
ORW: vsito pmepo e
Type of Project/ Activity
(ScaleyJy�.i
Shoreline Length �� �e„�
Access Length
Pier Idalength e/
Fixed PlatfHorm(s)
Floating Platforms)
fingerpler(s)
Total Platform area
Groin length/g
Bulkhea Ripup length
Avg distance offshore
Breakwater/Sill
Max distance/length
Basin,channel
Cubic yards _7
Boat ramp
Boathouse/ Boat ift,�,
Beach Bulldozing a i
Other i
SAY observed: yes no
Moratorium: n/a yes Site Photos: yes n%e
Riparian Waiver Attached: es %no
A building permit/zonir)g permitdy 6 pte required by: �—
/�Vot
y TAR/PAKNEUSE/BUFFER(clMe we)
❑ See note on back regarding River Basin rules
See additional notes/conditions on back

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: zs'.� /S
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Sn"Z.vDs ,�A r A/G Z83(60
SOg-1(7/- o921
S#0ENcgfL.7016-® Oyri'odl:�Gor�l
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 7$$ / SEy wf}Z c
at my property located at
in OM51-0,•) 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:
Signature
Print or Type Name
Title
/�2
Date
This certification is valid through

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: L—r&,AI/E
Address of Property: /y// Srte2eS Die. 5,-Csls6exy
Mailing Address of Owner: S-y ME
Owner's email: Lt A&V/-' 5Af ve2A 2ol6,e Owner's Phone#:
p ✓reuuG, cur+
Agent's Name: NNE /5�42inij Cy.fr^ r. ,Agent Phone#: 9J d 3?7 — 3 Y2S
Agent's Email: Zyy r7,r IV41z1 iyg CnivsrR 0<770,.✓ a� �i rNfl /d Co iy/
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.
��fll9L
QNi T� 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 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. 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 sign
the appropriate blank below.)
I DO wish to waive somelall of the 15' setback
o P' pt.-OR-
��rfl
SignaturAjf AHjacenf Riparian Property Owner�
I do not wish to waive the 1 S' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner- j/t : j�
PI-0hyped/Printed name ofARPO:_�4�/<
i/rttS Mailing Address of ARPO:
Sr, ,0914 ARPO's email: 14 LOMARPO's Phone#:
Date: it ,7�*waiver is valid for up to one year from ARPO's Signature*
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 portion to be completed by owner or their agent)
Name of Property Owner: - LLNn//F SFEn/c �/2
Address of Property: //'/y CVwz,tirc% $r>alltS �/L ��G>➢�S��2hy
Mailing Address of Owner: _SV Ms
Owner's email: Owner's Phone#: SoS'- V7/' 0923
p urcwo,e , cy,n
Agent's Name: Faa£r�r /`%.4¢,nig C,yssx�crwAgent Phone#: 9/ d --927 — 3 �'7S
Agent's Email GrVNETT M 44/L nrE C NSTR v=776i'✓ q%�
ADJACENT RIPARIAN PROPERTY OWNER'S CERTIFICATION
(Bottom Portion to be completed by the Adjacent Property Owner)
I hereby certify that I own property adjacentto the above referenced property. The individual applying forthis
permit has described to me, as shown on the attached drawing, the development they are proposing. A
N!r/oL Gl.
Dom£ A DO NOT have objections to this proposal. I DO have objections to this proposal.
It 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
malted to 400 Commerce Ave., Morehead City, NC 28557. DCM representatives can also be contacted
at [phone]. 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 sign
the appropriate blank below.)
1 DO wish to waive some/all of the 15' setback��
81.-OR-
��rfl
Signature of Adjacent Riparian' Property Owner
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian Property Owner'/ l
Gorpt-41Typed/Printed name of ARPO:%c.%�—r/+rg�L
Trit= Mailing Address of ARPO; //O 7 51-la2YS ��✓
Sy *00A ARPO's email: �i�719�; (��yi�a is ,GsoARPO's Phone#: y/d
Date: Zz. *waiver is valid for up to one year from ARPO's Signature*
Revised July 2021

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