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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 �/ ML I