71156A_Barbara McKee_20180831

JCAMA / DREDGE & FILL
GENERAL PERMIT
xNew `Modification ❑Complete Reissue ❑Partial Reissue
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 I SA NCAC
Applicant Name I
Address 1.t ? / 21JU'i-�
City State AlC ZIP 2717,Z
Phone # (M)?�{ �254 E-Mail
Authorized Agent h.v , U l tu
Affected ElCWEW ��TA '(ES ❑ PTS
AEC(s): ElOEA ❑ HHF r❑`IH ❑ UBA ❑ N/A
❑ PWS:
/�ftV1� L /
Agent or Applicant -Printed Nam
�ignat lease read compliance s ement on back of permit*
G/
Application F s) Check #
N271156 B C D
Previous permit #
Date previous permit issued
`,�11 • I�i
) �7 Rules attached.
Project Location: CountyCIkVuii!y
Street Address/ State Road/ Lot #(s)
l LIJAsa1/ d1 Oi , i)otle
Subdivision %Zi2 Ci t u I, 1 �1
City ZIP 2-717'Z-
Phone # River Basin
Adj. Wtr. Body i?It h!q /man /unkn)
Closest Mai_ Wtr_ Bodv :>< t1 lU n
1—`er\)r.i /VVW I H!S
PermitOfficer's Printed N
�{ �— ( 1 �yy, T,
Signature
Am7i-721 1701e;�
Issuing Datle Exp iira on Date

'A
I hereby certify that I own property adjacent to 11— tx � ` � 's
( aff e of PrQ,rty Owner)
property located at �+
�\�� c�V� (Address, Lot , Roa ,etc.)
on � �\ , in , N.C.
(Waterbody) (Cityfrown an/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I 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)
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)
Signature
h}nn e S
Pastor Type Na �� /Print or Type Na e, o
Mai dre 1\, (� NJ�ding A dress
C �V� ��" l�� Lcl %� o y 11 C 1-1
Cl tat i U 04o State/Zip
2S` 2- 3 3 q-
Te/ephwe Numker/email adds Telephone Number/email address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY STATEMENT
I hereby certify that I own property adjacent to � )oOT-0- mc..1�-+•C' 's
n , , (Name of Property Owner)
prc
on
in V—, AeA'A 4� , N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I 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)
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)
lk�� i V\
Signat7e _ _ �_ �'r ^ -
Print or Type Nap
�
Mai g fl ddress �rC( 3 2
�I,r'� 32
Ci /Sta�e/Z,� S� -`,iZS to
TO hone Number/email ddress
'- - 2 Y--,- 2sal`
Date
Owner Information)
Si citure *
Print or Type Name
L CcJ[3 & .
Mailing Addre /yC 2 22,?L
City/State/ZNp
711- 1 _ 21 Z /) 7115
Tel yh n2e N L ber/email address
% %8
Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*