71127_Rodney Washington_20180816

;�CAMA / DREDGE & FILL
GENERAL PERMIT
kM�N -Modification ❑Complete Reissue ❑Partial Reissue
No 71127 c�
Previous permit #
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 15A NCAC G�1 f I 1-2 `f'�'
41 Rules attached.
Applicant Name PoOiJE.Y W/As i4 trJ&ToAl
Address 17 o 6, 4 L t=' City,cF�`i:(,Ll/I �(( State ZlP ZU�� I
Phone # (3e.=1) & 1 _ -7.631- E-Mail
Authorized Agent
Affected ❑ CW PVW 'PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
Agent or Applicant Printed Name
Qom" P w�
Signature Please read compliance statement on back of pqrmit
�c,"�f T IN
Application Fee(s) Check #
Project Location: County C t rWAn!
Street Address/ State Road/ Lot #(s)
B C D
14Y� C'cut j r6 1->
Subdivision
CityUN ZIP
Phone # ( ) GI x — %31 River Basin PA S4X4C rA,1 ki I<
Adj. Wtr. Body�/_-�,L 9 &__ AA A/Lt,-- at 'iman /unkn)
Mai W♦r R-4— 'c'-,e'l I► I n
LYNti I .. h%A T-H I S
Permit Officer's Printed Name .
Signature
Issuing Date Expi Lion Date

1CAMA / D DREDGE & FILL
WGENERAL PERMIT V
Previous permit # A B C D
i_'New 7-Modification Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environment and Natural Resources Date previous permit issued
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC(�
C' i f l I { c,
Applicant Name
Address
City - - t uA l ( 1.�--
State_J�j _aZIP ZL 7'2
�����
Phone # (-Nr)
(�j--�j/_
Mail
Authorized Agent
, �r, A
o 1 w i
Affected El Cw
XEW XPTA
)(ES ❑ PTS
AEC(s): 0 OEA
0 HHF ❑ 1H
❑ USA O WA
❑ Pws:_
ORW: yes
PN yes/
yy s / no
' � Rules attached.
Project Location: County_ S 4 4A t� J
Street Address/ State Road/ Lot #(s)
Subdivision
City- 3 fit' ►r`'h) ZIP -
Phone # (_) River Basin, , ,
_
Adj. Wtr. Body_____ '`�.t Y.+, 'i A(� {..L, TI<
man /unkn
Closest Maj. Wtr. Body —
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s) [
I
I
Floating Platform(s) i
Finger pier(s)_ ----— I
Groin length
number -- { I I (�
i
Bulkhead/ Riprap length
avg distance offshore
max distance offshore �„M
"—_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
horelineLength —i + -'
;AV: not sure yes 6'J
loratorium: n/a yes
no
hotos: yes no
/aiver Attached: yes l
(Scale:�1
building permit may be required by: } (:, A I A I »r
Vote Local Planning jurisdiction) ��� DSee note on back regarding River Basin rules.
)tes/ Special Conditions
t or Applicant Pnnt
a j
ture , , —;Please read compliance statement on back of permit
:ation Fee(s)
Check #
I
PermitOfricer's Printed Name
Signature
1
Issuing Date
- r
I

r.,
r
�.a• 1 �.;'.1 s .�
r
It
rzq
f 163 69643
�r
40 � w r
w
1�
M
The materials available at this web site are for informational purposes only and do not constitute a legal document.

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
,
Name of Property Owner Requesting Permit:K,dw(l
Mailing Address: 1 �d,� bor4 Covd-
41,+(. eIIv,!Ie: P6 -)0721
Phone Number: So I- b r 3- 70 3 p
Email Address: �ee� ,G�/Zw' q,44AJ • COM
I certify that I have authorized t'`� h► I"� S CD�r�uGe<�
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: epIc"Ce
de krl'ofeitod doek pi e✓�
at my property located at 1 �� i�unf►'� C f qh DC, Le rdejtui A16 a 7 j,�
in Ch0U%41,1 County.
1 furthermore certify that 1 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
hr 11 rc°�
Print or Type Ame
©Gl%t�t.QrT
Title
Date
This certification is valid through / Z I � 1 /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ,111��(Sh.✓j (��1 s
( me of Propeity Owner)
property located at
ClM Vr
(Address, Lot, Block, Road, etc.)
on A1&'(QCA6 -�ly( , in rd- 4t-twn , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
�t°plq�e, dekfflofata docelpi'e(
WAIVER SECTION
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. (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 15' setback requirement.
(Property Owner Information)
(Adjacent Property Owner Information)
Sig t at re
Signatut e *
Print or T p Nam
1:70
Print or yp Name
Maili Address
Kul �A16 9�� L,
Mailing Ad ess
City/State2ip
3c'i- (06- ?b3
City/State/Zip
S.2- - 7/c/
.2
Telephone PuTber/email address
Telep one Nu ber mail address
Date
Date*
(Revised Aug. 2014)
`Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �us`���� ����� s
;r ( me of Propeky Owner)
property located at
Ct40 V(I
on Al/� 1 c �I (Address, Lot, Block, Road, etc.)
bz'rZZ�,l1 e- JNyj.' in �12r1J -Lvi , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
7 1 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)
�CpIqLe' dC�er�� � tee C 0C'e p��Vi,
WAIVER SECTION
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. (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 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
�Y
Sig1 at re
Print or Typ , Nam
t cl-"
MalltrIQ Address
e t
City/State/Zip
3C',- (ali-7V3
Telephone Number/ email address
Date
SZg tore *
� t-, z0.b e-rtn
Print or Type Name
Zoo CvL.A-fru 0-1�b��.
Mailing Address
I-jevAt 0r, , NC z-7Ct 3Z
City/State/Zip
15z- 3-YA 5Ll42-
Telephone Number / email address
B -r -Ig
Date*
(Revised Aug. 2014)
'Valid for one calendar year after signature"