72108_07H.1200 Excavate_20180504

CAMA / 'DREDGE &FILL 1�� / G 1 Oo - A \ „ C D
GENERAL PERMIT Previous permit# V
New ❑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 15A NCAC + 2�®1 i
Rules attached.
Applicant Name NA iilGy Project Location: County" 4t-T'y T .
Address 'Z'
71l $ Z /A y � tZ. c ��'� Street Address/ State Road/ Lot #(s) '©r=� SiZ City CNoGo w� ! ,T' State :_ ZIP `4_1$1 -7
Phone #.(ZTL) (023-71 d E-Mail '
Authorized Agent - (� c-� 1 $013 6A2"�7 Lr E
Affected ❑ CWA, ` TL,EW ;PTA ❑ ES ❑ PTS
AEC(s): ' ❑ OEA �HHF ❑ IH ElUBA El N/A
❑ PWS:
ORW: yes /(na D. PNA yes no
Subdivision —
'City �i�oGvw��lr;r�. ZIP -Z--7
Phone # ( ) River Basin I`A_-PAPM Li Y cj
Adj. Wtr. BodApt• C �4-v ��'c�- (nat'l mangy/unkn)
Closest Maj. Wtr. Body '?Am L1 CQ _1--1
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Agen or Applicant PHAT6 a
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Signature ** Please read comply nce statement on backof permit
�yoo 3,Uy ,
Application Fee(s) Check#
JO�Gl�0.`ti C'1VW�\�
Permit Officer's Printed Name
Signature
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I.hereby certify that I own property adjacent to�g7 n f� d 114 &Ar,, t9 s4e-eP- 's
property located at d `f Y 1,,�S ha r_ U r J e_ ,'1h0 C0&J /-LJ�a Al C:
(Address, t BI�Rmadetc.)
on , in A C.ri7 W fiiw� eLk. - -t0. N.C.
(Waterbody) (Cityffo n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAW- G OF PROPOSED DEVELOPMENT
liic�jvidea=' o'�os�i��[e�e�o iiaent'mrasffetl�iri�`.�escri`iro�d:�el�irugr�atfa�%asste;�9ratnrl�%g.
WAIVER SECTION
[-understand that a pier; dock, -mooring pilings, boat -ramp,, breakwater, boathouse, Iift, .or groin
must -,be set backa minimum distance of -IV from'my area of riparian access unless waived by
me. (If ,you -wish to waive the setback, you mutt -initial the appropriate blank below.)
I do wish -to waive the 15' setback requirement.
V/ I do not wish to waive the 1-5' setback requirement:
.(Property,Owner Information) (Adjacent Property O'Wher information)
Si ature
Print6r T e ftfn b
orC. Y
tir g Address
h000wtn4f ) 0IftI=9a91
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Telephone Nu►hberl emefil alfdr&ss corn
4 -A-7-1 I?
Date
Aimtd j
Vfi dust/ a er»,_,�
�EI,r-awI'
bale*'
(Revised Aug. 2014)
*Valid'for one calendar year after signature*

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Tracking Number: 70173380000012834139 Remove X
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