63480_Gordon K. Pippin Jr_20181217

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Previous perM!t.- 1EN1r=AAL',PERM1T
NeW--' ElModificatio'n DComplete'lk6issue'ElPaitial Reissue Date.'previous peribitissued..
-of North Carolina, Department of Environmental Quality As autHorlidd by th6,Staie -11 o
and ,the't'oas'ial'Re'§'d'ur'c'e's 68 immisision in an area of environmental concern pursuant to I SA NCAC-
rg-Rules attached.
Applicant Name Project Location: County
Address"-: 0, Street Address/'State - Road/tot #(s) C
City 'F�, Af b:.A 3c:, V 1'e L---)
State'.4 L ZIP - '
�71 L�14 �411 �.E-Mail' Subdivision Phone, A
A6thorizecl'Agent A4z
EJCW -EW S .VPTA 2�E [OPTSAffected
E10EA' EIHHF DJH ETUBA //EJ N/A
AEC(s):
El PWS:
ORW: yes -�/ no PN_A - yes no
City i 5A­r��
,Phone # River'Basiri—('7t,42 PF) r.L. L_ 1 L�
Adj. Wtr. Body_ •an /unkn)_'_.".
Closest Maj. Win Body L C� U
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FA
A. 111i
lijo A
eritior pplicant Printed Name
44-
Signature Please read compliance statement on back of permit"
Application Fee(s) Check #
Y
PermptOf i cer's Pr!pted Name
Signature/
7 n
Issuing Date Expiration Date

A.udsorized Agent Consent. Agreement
I, 60 r C�C /� { P p 2 , derby authorize Tobin Jay Tetterton of
(Property 0%,Yner(s) )
TJ's Marine Construction, LI.0 to act on my behalf in obtaining CAMA Permits for
the location listed below.
PROPERTY ADDRESS:
1"305 aAYvIEw
^g or T (+ iv c 2 -7 Quo 0
PROPERTY OWNER'S MAILING ADDRESS:
Po '�ok 1 q 5
A T �4 NC Z-7&0 8
Phonc No. 2 S 2 —
PROPERTY OWNER'S SIGNA
AUTHORIZED AGENT SIGNA
DATE: Nf.5'f -216' 201a
W/Autlwrized Agent Consent Agrm

! t�erehy certKy that i own property
PrOPG? Gated at f
on !"T nn ! .'
V
of
The applicant has described to ma, as shown bolo (�a�y1'!i'®w a�dl®�®���
location. w. the development Proposeel at the above
kriaoant.� E have na• objection to this• proposal:
Owner
theokaae ---._. ! have objections to this proposal.
DESCRIPTION eoDJoR �n�us€ 1G �� PR®PQAndividualMOPsng ypinent BEi ®1�
da�below oF s�ach�z1fe draftn9)
��t l Q46�
Aj
PM" f understand that a pier, dock, moorinrIngs, must be set back a minimum distance o€ boat ramp, breakwater,, boathouse, ltll� or groin
r` tne. (I'
you wish to waive the setback
r,t y area of rlpartart acoess unless waived by
ors t You tes st MIN tine epproPriate blank below:)
1 o!a wish to waive the t6' setback requirement.
------�vlsh to waive the 75'8etbactc requireme48f:
bye
®waees' Osa OUMBRIOR
L� jz� ,
r,
Duie� ,
" Vafld for one calendar year after signatuW (Revised Aug. 2o14)

-27-2018 13:36 From:
To:912529436389 Pa9e:1/1
i he�Y cerW that l ovrm MPe
* ,jacentto
AroOeft fa teed at ,
�
an {rBresa
in
. . ° The placard has d lgsa¢y'yGWR
ld esoriQed % me, es shoyyfl below
A�tamnr , the daveiopment prop,
R„ t have -no objeotiOn.to this,prapasai
Q ,
n► c�,e --- 1 have Objections to this proposal,
® C�l�T9�ly A Mjt ®�Wt M np
(Ofiaiivedued; p��pasin,,� d®velgpxnen� musf fl7f In d ®pA
acr'Jpt#ort below or attacl
c
;Klr-1
Fak►
of
l Urlds"nd that a pier, do t� $�2rtn,nAv
mast be set back a mirdm �mooca$ AM90. boat rerM, breakwater, boar
;Lfyou wish Ua the se dF 95' from my a►8a of tlparian access
tok, you teiiiaf the appropfte bbmk b
l do wish to waive the 18' setback
• r+squfroment:
do
�_
t�f wish to Wsiva tha 9$'seibeolt reqUiremeM,
'Valid for one oslendary' awaftarsignaiur� .
N.C,
St Me above
e silos erg
e, lift, or groin
M Waivad by
a
Aug.2Mjj

Applicant:
Date: / -7 1� EGEM$C'�Z 20
4General Permit #: -72 9 G%
Describe below the HABITAT disturbances for the -application. All values should match the name, and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated trial
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Naive
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp -impact
temp impacts)
impact amount)
temp impacts)
amount
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Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑