63562_Robert J. Rich_20190110

_JCAMA /."❑ DREDGE & FILL NO. 72044
's.Lr GENERAL PERM IT'. Previous permit #
ew ' ❑Modification ❑Complete Reissue ' ❑Partial Reissue Date'previous permit issued.
As{authorized by the State'of, North Carolina, Department of Environmental Quality. a
`,arid, the Coastal Resources Commission in an area of environmental concern pursuant to I5A'NCAC 1 ''2._c��Z)
Rules attached.
Applicant : Project Location: Coun, ,vityT
` �- �, `��� ^'�--¢ Street Address/ State. Road/ Lot #(s), (=. ►� �" C j r " Address- 3V lam' . G Y �'
Cityl,,-%A�i� C�-c-f��1 ": State i`_) -ZIP-Z,�
Phone#(2��-�i `)i�- (ofS--LQE-Mail Subdivision
Authorized Agent' iy 'GJ cU („ J 4L_A;-' City AVA-.2 'r4-,- 1
❑ CW EW TA [I ES ❑ PTS Phone #
River Basin
Affected l� (_ )6L �� C�
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. VAr.,"Body. �� �� ��y vEl Pws:
� (nat, man. /unkn)
y ORW: yes / n� PNA yes( no Closest Mal. Wtr. Body �--
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V�,,�el GPI+r�
Agent or Applicant -Printed Name
Signature Please read compliance statement on back of permit
Application Fees) Check #
('7Q. 4'�:LLIJ
�ernnit©f icer's Printed Name '
Signatur d `--
Issuing Date Expiration Date

_Bob Rich , owner of the property located at:
(Name of Property Owner)
306 Cypress Shores Road Was -bin". NC 27889
(Property Address)
Hereby authorize Michael Goltra (Goltra
Builde
(Name of person or company acting as agent)
To act as my agent for the purpose of obtaining any needed Coastal Area
Management Act and/or Dredge and Fill Act permit, that may be needed for the
proposed "development at the above indicated property, which entails:
(Describe proposed development for which permits are being sought)
This agency is limited to the specific activities described above, and will expire
on:
(Date on which authorization expires)
, (11�' 4 . Ll9
(sign e) N (Date)
�)a6 k"��
(Printed name of owner)
(Title, if officer of corp. owner or tntstee for pmperW)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to DCLYJ U) PAer f y 's
(Name of Prop rty Owner)
property located at SO&
(Address, Lot, Block, Road, et )
on �Ctmtte-Q (y2� , in W (nI n Q WA , N.C.
(Waterbody) (City/Tow 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 ANDJOR DRAWING OF PROPOSED DEVELOPMENT
VIM)' r r " :e ,,,rr s • r E 't f i 1�s o !� Y5 s: ':, * n x�, ��r ",�Y'
f�.. z"�..��%...'M'� ",� �. � ;.tom ��s���,r�,Ch�.��J..,���sv„�+-����su�'�.�::�.� •���'s.i.�, ir,
Gover-1,1 (Z x 1Y p"'iffo/w1
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)
Printer Type Name "
30.6 C..o tes S Slues P-4
Mailing A dre s
W G S� (\A t % . N. C. 27 w
CiWState/Zip
ZV-946-N2,1
Telephne umber/email address
III�IL
Date
(Adjacent Property Owner Information)
Signature
x IJa We erl
Print or Type Name
�VieA Wea' eie 3y�-�Are55 S�otes 1?�
Mailing Atidr ss
o151nrnt W.C. 2185'�1
City/State
2.52 - `146 -6d6D
Telephone Number/email address
l0
Da e
(Revised Aug. 2014)
*Valid for one calendar year after signature"

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I -own property adjacent to i-b0, E_ : - 2214r�f__ 's
(Name of Pronerty Ownerl
property located at
krkuul Caa
on QQm tics) R;ye(- , in
(Waterbody)
'k, Road, el
(City/Town
d/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatior,
✓ 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION•- DRAWING OF -•-oDEVELOPMENT
'W.-
coveri'�� tZ x }y P I of-�v�- r►-�
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.
(PropertWO wner Inform tion) (Adjacent Property Owner Information)
i n .
u c�nucrci c
Print or Type Name
2�ol0 R«k
Mailing Address
sob . pfts S�oreS
City/State p 6
Telephone Nuffiderlemail address
2s 2- 9146- 6V_ 9
Date
*Valid for one calendar year after signature*
Signatur
Print Li Type N m I/
Sq I i.
Ig Address
I Saw�e� Gf.
qiVIState/Zip
Telephone Number/email address
2_51-9�9- I Zot
Date * I h o' I°!
(Revised Aug. 2014)

Applican� ►fit- z-r 61 a
Date: 10 T
-General. Permit #: --2 2
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Blaine
DISTURB TYPE
Choose One
TOTAL Sq. Ft -
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
tem o impacts)
FINAL Feet '
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
-�
Dredge ❑ Fill ❑ Both ❑ Other
2'i-�'
�2
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑