HomeMy WebLinkAboutGladwell, Charles & Vauter, Ray (need Permit No.))C
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REOGE I FILL
E NERA L PERM
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A buld'nt P€rm't may bG req'''rcd b,See note on back regardrnS RNer Easan rules.
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Name ol Propeny Owner Requestrng Permi:
furlailing Address
Phone Number
Email Addrcss:
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I certity lhat lhave authorized
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to act on my behall, for the purposc of applying for and obtaining all CAMA permits
necessary Ior the following proposed development
'|-+ L Environmanll kfOi c-o,LDL to a-a ) floa-ka1
at my propcrty located al l!a- $ayv ) -v,)Btvl, *+t a"tti c- Dzach NC
In ,-1r-tLral-County
I fudhermore cedily that I am aulhoized b gran'' and do in facl
Dtvision of Coaslal Management slaff, the Local Permil Oflicer and
oi tni ,fon*"ntioned linds in conneclr:,n w h evatuating inlorm
permil apqlical,on.
Property Owner lnformation:
g@nt permission lo
lhcir agents to enter
alion related to
:lgnalurc&t|&Les .,ht,dare /,L
Pthl or Type Name
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RECENED
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AGENT AUTHORTZATION FOR CAMA PERMIT APPL-ICATION
hrru*lr;tu -AL-AlA/o
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TOm hrraon uJ of
I hereby certify that I own property adjacent to L'
Name of Property Owner)
€LAn"e{
property located at
(Address, Lot, Block, Road, etc
on AoLot Souti ,in N.C.
(Waterbody)(City/Town or County)
The applicant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have obiections to this proposal.
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WA]VER SECNON
I understand that a 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. (lf wish to waive the setback,you must initial the appropriate blank below.)
_ I do not wish to waive the 15' setback requirement.
(Property er lnformation (Adjaeent Owner lnformation)
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Signature
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Sign /bsoor
Prlnt or Type NameIli otAv€ t^)Pdnl or
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Name
Mnfig Addtess
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Telephone Number / email address Telephone addl'sss
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(Relilf(d,tA.M)
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Date
'Valid for one calendar year after signature'
Date*
Number
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
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DESCRIPT]ON AND/OR DRAWNG OF PROPOSED DEVELOPMENT
(lndividual proposing devetopment must filt in description below or attach a site drawing)
I do wish to waive the 15' setback requirement.
RTY NE TAT T
i of Propcdy Owncr)
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I hereby cerlrfy that I own proPerty ad,accnt lo
property locaicd at
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NC
Tire aoDlica
ttcatior./lcl-
(Cityn'own and/or cou.rtY)
trthasdescribedtome.assho{,nbelow'thedeveloPrnentproposcdallheabove
I have no obicclion lo tlns proposal
t have obiections to lhls Pro,rosal
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DESCRIPTION ANOIOR DRAWING OF PROPOSED DEVELOPMENT
dcscription below or attach a sile drawing)(lnlividual
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it)
g deYctopment must till itt\
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il-ll i"s s''a
fk, flar,.'Ny Flal>
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VER SECTION
I undersland lhat a pier, dock. mooring Piling
must be set back a minimum distance of 15'
me. (lf you wish to waive the setback. you mu
Cj- ,dc wish tc waive lhc J5'setback reqrtirement
ldo not wish to waive the 15'seltracl' reriuirenlent
s. troat ramp, breakwaler, tloalhouse, lth, or groin
from nry area of riparian access unless t,'laived by
st initial the apFropriate blank bclow )
(Property Own lnfo ,"9 (n (ljiiuent Propcrty Owner lnformation)
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(Rr.v6.2.t Aug 2Ol4J
RECENED
MAY 0 5 2020
DCU.MHD CITY
'Valtd l.,r O e Calenda, _veaffifler ::Qnrlur!1'
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{Waterbody}
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