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HomeMy WebLinkAboutSloan, Jim 76690CA.hI trirodf,atr dt.fudtladrrdthe€dRemc Applczrr Ptrdrc Aftcced A€C(s): CT a OllY: lrr,ti{A vs I / SDEDE rHI,L PEBITITOCometAtr--e*tlRere Mail - Derek smith - Oudook Oo6!!a ilaS !Yrr" N9 76690 Prf,irsplrdt Datr ABCD* Cro:rr,Ocprurr dEmttomrrrrf QrlyCsrr&aonh }T emtmFr*lmo l5A Proirtlodonl StresAdddsuts ld. trt trrrs0rIA trttlA Pho{p # AdL Wtr. t /l[ r rt (Scrle:) tp. of ,!ofG.{A.dtlry E F &.dr {, brr Bd,rrtp Flcr(dod., qt*'-"n rrudrar.a fcdffirg ftr5r sAv:nC llra Abftpcrn*nry ( r.f6. bGr' f*a*:q ah ftc $fferEld no6 b.d(Bch I Ix 1t2 AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION Name of Property Owner Requesting Permit: Mailing Address: r rv.\ sl bf,rL q9a t-b. {,LJ bf \lc E-ts-l Phone Number: Email Address: ?-> - )t4l '?rq-| tI certifr that I have authorized M nt / Contraclor to act on my behalf, for the purpose of applying for and obtaining all CAMA permits necessary for the following proposed development: 1 +*lal Ao'g;-6u t\" t0r-(I at my property located at 5 0 I fufthermore ceftify that I am authoized 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. Propefi Owner lnformation: t, Signature bar\.-- Pint or Type Name Lil ^.0.,fTitle ( Date RECEIVED JUN 10 2020 DCM-MHD CITY This certification is valid rlrrougn b t L t 21 iM-county. >-o I hereby certify that I own property adjacent to ira.-S/o^,^-- property located at 1 Saa of Owner) B o L42-on tn N.C. (Waterbody) The appl locafion. described to me, as shown below, the development pmposed at the above I have no objedion to this proposal. I have objectlons to this proposal. DESCRIPTION AND'OR DRAUYING OF PROPIOSED DEVELOPTENT QndMdual Noplng deyelq,/rwr'mu6,tf,ll ln d*c,rlptfoltt tp,loy, oralbch a strodtawlng) s /4/^, /../ WAIVER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathousa, lifl, or groin must be s6t back a minimum distance of 15'from my area of riparian access unless waived by me. (lf you wis),lo waive 4oo*rn, the setback, you muit inltlal the apprcpriate blank below.) waive the 15 setback rcquirement. Owner _ | do not wish to waive the 15'satback requirement Owner (AdJacent )I 'TYf*9Bs*.</- w Addless ^Jr JXSro -a{l - 3to9) -*TW"** 7zr"d1r ,L LtSS4 8 o addrBss RECEIVED (RevtsadAw.zaf.if I 0 2020 DCM.MHDCITY kn J Print or Telephone Date l/alid for one cal6nder lrear after signaturs' Date' (Clty/To*f and/or Gounty) l-otatoVffffltc)o/6f- Sec- Legend ? 179seao O Untitled Map Write a description for your map. li J I1l ;Fr i-1,r l.: -i 40';2o"'f u b' xqoo' r.ig\at &c'L - !,oa* Ltl| Fr.- =-l 1 t l' II E F e 1T ,/t H ,.' ll I A NGoogle Earth 300 ft AOJACENT RTPARIAN PROpER',ty OWNER STATEMENT I hereby certrry that I own property adjacent to Sr-'*..S\oan property rocated at \ 1 q &qT-ara LnA:-" of Prcpefi owner) (Address,LoS Qlock, Road, etc.),15s*"oo. \ 's on in N.C. (Waterbody)(Oty/Twn andlor County) The applicant has described to me, as shown below, the development proposed at the above location.l/ I have no objection to this proposal. I have objections to this proposal. DESCRIPTION AI{D'OR DRAWNG OF PROPOSED DN'ELOPIf,ENT (lndtvtdual prrytng developnanf musf fitl tn dwriptton betow q allach a slfa crnwtng) <e, uilfu;\ WA]VER SECTION I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin must be set bad< a minimum distance of 15'ftom my area of riparian access unless waived by me. (lf you wish to waive the setback, you must inlfial the appropriate blank below.) do wisfr to waive the 15'se0ack requirement. I do not wish to waive the 15'setback reguirement. Oumer r) ) {. i/\ ( address "f $*("'\",t<L^*, ryW'm N( r\s7D CivStat*Zip Teleohonej,lumber / email address \4ff4- fi -y . ;t() l,1r- RECEIVED (Revi',dAus''o'!,lN I () zo2o Date Valid for one calendar year after signafure' Date* DCM.MHD CITY Legend q 179 sea Trace Untitled Map Write a description for your map. n Ln ;L**;tt t- bt Xc{OO' trogs\ ".\ )uL !oa,{ L\+'iltl 2o' I zo"T I' A N a I t t^L E Google Earth 300 ft