HomeMy WebLinkAboutSloan, Jim 76690CA.hI
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
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Phone Number:
Email Address:
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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:
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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:
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Signature
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Pint or Type Name
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Date
RECEIVED
JUN 10 2020
DCM-MHD CITY
This certification is valid rlrrougn b t L t 21
iM-county.
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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)
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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
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RECEIVED
(RevtsadAw.zaf.if I 0 2020
DCM.MHDCITY
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Print or
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Date
l/alid for one cal6nder lrear after signaturs'
Date'
(Clty/To*f and/or Gounty)
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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. \
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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)
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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.
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RECEIVED
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Date
Valid for one calendar year after signafure'
Date*
DCM.MHD CITY
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