Hiatt, Jeffrey 84233C

54CAMA ❑ DREDGE & FILL NY 84233 A B v D
1) Previous permit /
GENERAL PERMIT Date previous permit issued
New ❑Modification ❑Complete Reissue L]Partial Reissue
As authorized by the State` of North Carolina, Department of Environmental Quality and the Coast Resources Commission In an area of environmental concern pursuant to:
I SA NCAC �� t t�� Rules attached. General Permit Rules available at the following link: ryd�SX4yLCAMr les
Applicant Name
Address --2)—
ZIP
I►� 1
Affected 11 CW EW PTA f ES U PTS
AEC(s): ❑ OEA IHA UW SPIMA PWS
OR :yes no PN : yes no tt
Type of Project/ Activity �10 �t ; = 3
r
Shoreline Length
Access Length
Pier (dock) length
Fixed Platiorm(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/a mef)
Bulkhead/ Riprap length r"
Avg distance offshore
Breakwater/5111 _ .--,- I
Max distance/ length .�
Basin, channel
Cubic yards /
Boat ramp
Boathous Boatlif _
Beach Bulldozing
Other
Authorized Agent
Project Location (County): 1h/1J
Street AddreWState Road/Lot #
Subdivision
CityC:1
Adj. Wtr, Body I" ---
Closest Mal. Wtr. Body � r ' r ►' " ' v
W
13�_f bc-Mff4-
(Scale:
SAV observed: yes (0
Moratorium: n/a yes 40
Site Photos: yes
Riparian Waiver Attached: yes no�k-
A building permit/zo imi ng pert ay be required b : -- . - — TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
See note on back regarding River Basin rules
- —�-- ---- ❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, Cfg RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please initial)
Agent or Ap))licapt PRINTED
is
Slgrl�ture "Please r d compliance statement on back of permit'
� hJ%cV/1 U _
Application Feels) Check 1 Money Order
Signat �/ ,?�
Issui g Illate ExlArati6n Date

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AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: JE��
Mailing Address: a 61, 0&1 e -o(u-I
Phone Number: 3�
Email Address:
I certify that I have authorized Bair bar,-
1"i�t,� ►�L
Agent / Contractor
to act on my behalf, for the purpose of applying for and o-b�taining all LAMA permits
necessary for the following proposed developnnent: �1 l�,� U ��
k ol)� L 0, " 1 ra ,41 ems- � Y
at my property located at � - ( �%1 '��.�Y� t� Y �'>0o -ff--, S (rA
in ) nS�o County.
I 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.
Property Owner Information:
Title
Date
This certification is valid through ___ l_

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N.C. DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERY
(Top portion to be completed by owner or their agent)
Name of Property Owner: 4>4 6 `�_+ L
Address of Property:
Mailing Address of Owne
c
r: SA al ' i . F' S c
_T,
Owner's email: �L I �nJ _*ner's Phone#: 3 J
Agent's Name: C I\ t` 1 �i rT� 11 Cl'l� 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.
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 127 Cardinal Drive EXT, Wilmington, NC 28405. 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' frorn 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
Signature of Adjacent Riparian Property Owner (ARPO)
go
I do not wish to waive the 15' setback requirement (initial the blank)
Signature of Adjacent Riparian
Typed/Printed name of ARPO:
Mailing Address of ARPO:
ARPO's email:
:f
� v
PO's Phone#:
Date: / — .�'7 ` ,' ) -waiver is valid for up to one year from ARPO's Signature"
Revised May 2021

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit'.�-Y{
Mailing Address* (, ka—e ,2cb- f _
Phone Number:
Email Address: N'��-1 �C 06 ILi-Ac r, o `�
I certify that I have authorized clr r'J�=r,, r �
�J
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �� <U <'� / ac-4e--
at my property located at �l 'f�CX� t 1 QY �+1�ilC P AWzr
in (i (15?b0 County.
I 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.
Property Owner Information:
s&. —
Title
- t l �'� _
Date
This certification is valid through

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number: c
Email Address:I�'-
I certify that I have authorized Ba, r bo r r7 Y, I V-k.
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
-
necessary for the following proposed development: pE- rr)G �'� I(-- kc-'l—e-
at my property located at
in 16k Q County.
I furthermore certify that I am authorized to grant, and do it) 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:
Nt
Title
Date
This certification is valid through / 1