HomeMy WebLinkAbout75842D - WuWu
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: wy tj J U -c-
Mailing Address:
Phone Number:
Email Address:
S'o) /Ay L
i certify that I have authorized V e` rr":
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:`����G'
at my property located at ,N -
in AJy.,u 1����,r��- County.
1 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:
4R�-
Signature
Print or Type Name
�, Title
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1n/U4f✓ 's
(Name of Property Owner)
property located at �o) � . L L� ,,%- ck A i r
�./ (Address, Lo Bloc Road, etc.)
onG'-r , in IJ"„' �iiaw,.- Ct}-
(Waterbod , N.C.
Y) (City/Town and/or County)
The
%applicant has described to me, as shown below, the development proposed at the above location.
V I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANO/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
I do not wish to waive the 16 setback requirement.
(Prope Owner Information) (Adja ent Property Owner Information)
signature _ SiFture
�-
Print or ItyName "
YS''`` 1 /f���}� ,[^�` `, Printr `T Name
Date Received
Data Diiipoitiiid Check Frwn N—
Namo or Pam it HoMw
Wndor
Chock kksMr
amount
Permit NuMbWCgnmrrnb
Columnl
Columnl 1 Column3
Columnl
COkww5
CiokN""
C61111am7
Columns
_ 5/2612020
5/26/2020
_ 5/26/2020
5/26/2020
5/26/2020
5/26/2020_
5/26/2020
5/26/2020 Grice Construction of Brunswick County Inc Ronald Foster
5/26/2020. Grice Construction of Brunswick Count Iona .Miller Gibbons
5/26/2020 Holden Docks and Bulkheads Stephanie Bass
5/26/2020 Willie Clarence RichardsordRinhudson Construc Ralph and Patricia Gallo
5/26/2020; William and Sharon Herring__ __ -Tommy Hernn9 _
_ 5/26/2020 McPherson Manne Services, LLC_ Thomas Adams
5/26/2020 Carolus BuildingCompany WuWu LLC
880
BUT
CresCom Bank
BUT
First Citizens Bank
First Citizens Bank
First Bak
13850
$ 200.00
GP #76524D _
GP#78512D
GP*75807D
GP #78514D
GP 076300D _
t76414D _
P
13849
$ 600.00
3739
$ 400.00
7114
$ 200.00
18850
$ 200.00
3124
S 1GP
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to AU V V �"'1-- 's
(Name of Property Owner)
property located at A j
�, (Address, Lots Bloc Road, etc.)
on �� in 1�4--/ �1�-C , N.C.
(Waterbody) (City/Town and/or County)
�\ The applicant has described to me, as shown below, the development proposed at the above location.
! 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 attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
h waive the 15'setback requirement
I do not was to w i s eq
(Property Owner Information) (Adjacent Property Owner Information)
Signa
sat 3f� .�
or Type Name Prin or e
w.
/V ��-.. Avg.. 2 �/
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