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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 40WA 4.STA 3 NA V sAN%Nif
Mailing Address: P') . 'D x SO /ne.7
St' 1PASJ NV VIsk3
Phone Number: C �L� '??S • G,3 Q - I S-O S
Email Address: AQui141r11 ?Al'?Av.. 10% fl1Q`i )• C
I certify that I have authorized Carolina Construction
V �
Agent!Contractor
to act on my behalf,for the purpose of applying for and obtaining all CAMA permits
#T
necessary for the following proposed development: 1�1� % w RQigs. R QpIq ce g }
%Tbe :RA iko►ce Wwg6a 6s4444 t.�-. R is lDar/i$uii4 toc k t R1,=
at my property located at 471 S . p 1(i Q.� R!V e i a 4 PR
�in S4+g,KCounty r
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner information:
Signature
Ake$‘AAP•b lit+ •
Print or Type Name
Cv - QwNJ EVLS
Title
e i I9 1 2.02.0
Date
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CAI A/ El DREDGE & FILL '
0 77845 A B C TP
GENERAL PERMIT -- : _•` Previous permit#
> 1New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued /
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 I 5A NCAC 074 2.5 C_X .
r-- ❑Rules attached.
Applicant Name �, ., Project Location: County �.,; c'ir.
Address C),...) R v,c 37-0- ►no Street Address/State Road/Lot#(s) c/S ),,-, I,(..,-
City )Qc:..lc 7., State'.. \/ ZIP �S 9 t12S 6/ .
Phone#(11. 'IC=0 (c-- I E-Mail - ,. r t-0,,1/4 • "-'i /Subdivision
Authorized Agent <-. . I ( tA v \\ City asz - (c t 3,,, ZIP 7%r'{ ( (
Affected ®CW ❑dEW C3PTA ❑ES ❑PTS Phone# ( ) River Basin L„ l-j> r
AEC(s): ❑oEA ❑HHF ❑IH ❑ueA ❑N/A Adj.Wtr. Body )% (< ; (v-,,- L( a an /unkn)
❑ PWS:
Closest Maj.Wtr. Body /1 (l '— i"'<-
ORW: yes /`no,% PNA yes / pa ( lI i r
Type of Project/Activity Cy:c9� ,\, ►7.,I�c.�,., _ 1crkc,, ,,,‘ , �-"1 (�'< iA„ ,
J
s,,., -1^, ``r, \�, (Scale: tJ T S )
Pier(dock)length 7011
1 I!
Fixed Platform(s) I '• I
Floating Platform(s) S )t ((11 ' �_ , ./1 (; ;-- :
Finger piers) ._ .`.. } ^_....__— ,c- j.....
Groin length
i f N 1 .....` f4K
number _ ._.._._ __—_—. . ......... .._._..__�_.. ............. t i................. .
Bulkhead/Riprap length SV —
i ,+ -
avg distance offshore i y,;1Z i•5,,,t.f.y 5.\ w,\M '
max distance offshore i ' 1111 l(i,
Basin,channel r
I - T {
cubic yards
Boat ramp { ..„;.-Li , Jul' , , 111 i , ,
, , ,
Boathouse/BoatliftvU ;
c _. --
Beach Bulldozing i v 1t . , -�-
���/ ri, �v.�/ :
Other P h ..—�-- . /L
, /
\� �L
Shoreline Length ^ co' Cy ,1 S6 ri.,/ L , fit. 1- 1- ,--- ',r r sic
SAV: not sure yes _.1. f� — — nF' ' ,._-__ - `I
Moratorium: n/a yes ) .� _ 1 . .._'..mi -- a_i eiop___
r ,- ,__. — I
Photos: yes no 1 _—i_ _. ............ ......_..--
Waiver Attached: yes ' j J �`�"1 (14e
A building permit may be required by: 0 CQ1--. \ i1 q F c. L • See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions ;" (-) (`L• .,\ 16. \, ( `^\ t-D,\W-,.. c `—,`i\ 6, , \4
c 4.1-4 - ( 4 \ , ,, ,... ,.....>3 ,,, \f--
Agent or Applicant Printed Name Permit Of s- N me .
\ ' "' ,_ \/‹. ._
Signature **Please read compliance statement on back of permit** Signature
'`' (,1207 0 21ij1ZotI
4
Application Fee(s) Check# Issuing Date Expi r�a ti Date