Phillips 72323 FLORENCE (2)

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GENERAL PERMIT Previous permit# n�fg9 B C
> _ !New ...Modification liComplete Reissue Partial Reissue Date previous permit issued IQ JIq/16
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 I r-+"11 Q500/1100/10e, .
�_I,y r I 1475
��' ❑Rules attached.
Applicant Name �j Project Location: County lieu,(f tick, ce# -
Address POS em( lode Street Address/State Road/Lot#(s)_S65 a RAs _r l
ci
CityArdrrdt BACA G State NC ZIP ,gas ,`"`
Phone# (110) ei7_ el4bS E-Mail Subdivision
Authorized Agent gliosia, City IAA 1 �� ZIP_ AS4 1'2.
Affected ❑CW I W Ii1PTA i 1 S NITS Phone # ( ) J River Basin C FR..44
❑OEA ❑HHF ❑IH ❑UBA ❑N/A �.`
AEC(s): Adj.Wtr. Body L eman /unkn)
❑PWS: i x
ORW: yes no PNA yes no Closest Maj.Wtr. Body &7 ���
Type of Project/Activity
(07##I /* f((GY►Sl7VGf pritta11 at4 i-tr"j(i --Ecih� d hit ahead /Yj
Q✓I q "Od.,f` 0-p 41- do'/'Yl 4 by rT cr aQ ria ono/ cj (Scale: 1 :40 )
Pier(dock)length 110 I*( b' /
Fixed Platform(s) I A f d' DC �� plv
Floating Platform(s) ✓y v'�I��Tr i
Finger pier(s) iteld I,
Groin length
number
i AD
Bulkhead/Riprap length /%4V ik ./ �. _'`
avg distance offshore b � �y
max distance offshore 0 + j .4 _ ! — --
�.
Basin,channel . i
cubic yards Av �''
D� `� •
Boat rampw rr (w•
91:1Boathouse !di A ie. �Ir(M * ,, '`
Beach Bulldozing A' '
Other fill/1_.- PIC .a_� X0°1
/n7 ?Q L
Shoreline Length 5)0 k
SAV: not sure yes Q i I " '
Moratorium: n/a yes 01
Photos: yes • u .
Waiver Attached: yes CO r , .
A building permit may be required by:jik(u jjrk.,r-Gy/)l/ I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)// /
Notes/Special Conditions ig / ! -401.14 6711- a k7/110 D/, no apply-fp ,r5 rz,jet"(eS"6vP.fl2�/�
as-..
o*u 1or4 i -E,,-fdial ►rI 4Q* n . Neil-6(114,es 43 J21kheal c /k° to
sItycl�(
�o $1 ,rnis 4007 rrG7q70 b Avid Ala k ,el nr 1. `r -,Qlpii�-i
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TQ, ) rl TE . *.n , ( I , Ftfrd ,4m!cd
Agent or Applicant Printed Name Permit ffic�nted Name
I Si re leas compliance statemen ack of permit** Signature
AIM AiM 10I 2I206 5 AO/aoicr 40
Application Fee(s) Check# Issuing Date ,w.Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENrT
r I hereby certify that I own property adjacent toi1ç�( le jJitL_ lAkt.4-1 r-s 's
me of Property Owner)
property located at . 4.C-Pj2,-,Ikktiel. PI •k )
Co-p.
(Address, Lot, Block, Road, etc.)on . A(Z , in A; I LIV1 ra)i-ivA .Ai.: 2I- , N.C.
(Waterbody) (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)
( (.Sz1 Pic'cr s12c
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 setba , you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
L \� , I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adj. =nt Pro. _ , g '}' =r I fo ation)
igture R41r- 18� �' � //' � 1z4u; i4/iOki , ,, aci(C4it15e
or T Name Print r Type N
I- V. y -' i D U ( ZeV0 (et k1
Mailing Address
,VMailing Address_,, i +
C `
A be, ✓I C a)5y7 W$
1.�lLt W NC 0- `11'17—
Ci /State/ZipCity/State/Zip
/L) - 6 r7 - ,156.s 915 i'l -707Y
Telephone Number Telephone Num er
da-r /41 3-0/-f l D „7o/moi f
Date Date
(Revised 6/18/2012)

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