73550D_TAYLOR, Susan

0 CAMA/ b •REDGE & FILL No. 73550
G NE - • L PERMIT Previous permit# A B C D
>�--% ew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina,Department of Environmental Quality 0�(Jam(j /)/oo
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC
Rules attached.
Applicant Name $041 7o7r7/4v- Project Location: County A/ r
4 S /l�{ddovv 1 '
Address 9 �� yVY�IYIQ Street Address/State Road/Lot#(s)
City_ 0 Wes y(i/vi, state RI ZIP / q04Q Do 4 .9)`P `I .AC-
Phone#( �&S 44-05 E-Mail S C,A2 LL T 40 ,16;,(6/Do Subdivision Sh 1 Wak4
Authorized Agent On City M 11'1'fC4 ZIP 84 iz
❑CW ❑EW ElPTA TS Phone# ( `J River Basin Cii ' 'qa1
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A °
AEC(s): Adj.Wtr. Body ( icMU/E' 'i. /man /unkn)
❑ PWS: �^
014
ORW: yes /� PNA yes / no Closest Maj.Wtr. Body - , (6tk
Type of Project/Activity fl)/2 S(c-(' '7b /}1 S1Td.ahu a'l1'l 41 LT J h� 4 .---
(Scale: /'0 )
i
Pier(dock)length ( I
Fixed Platforms) gig,,/ ,F L,— j/� • I
Floating Platform(s) ", . ...- , ii
Finger pier(s) /�, r.a _
Groin length iv",
iiinumber t�tl
/g 'iprap length 15 �, `i
avg distance offshore { — ` " t ���
max distance offshore I Basin,channe i
1
. ' A
cubic yards V 1^ 191/6 - _
Boat ramp 1 ,! if .
Boathouse/Boatlift I
wIr" ___ -.---....:-.-i- L , _ _
Beach Bulldozing =t� ��r�
f Other 5 /30 .I i I ,
1/6 /3Q -A
0z i 1 , 1Qt,0 D j
i
M i , ( ( C (
Shoreline Length "4$ 1 � _ —
SAV: not sure yes6 —ill — �/
Moratorium: n/a yes o , I =� ��! �
Photos: yes - ��P-- 3 ._ _.___ UJ'•' q ffli�' i ' '
Waiver Attached: yes
A building permit may be required by: !V 9VI7' ColiOwnir I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) 1-{/�w �`�'[J'��,� /yam ��a�Q /J� �Q
Notes/Special Conditions ASaei ( Q7i///� dS �K�4 aCa af r ae
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1OL f frrck i1(v
AgentJrQUk
licant Printed Name
Permit�Grint d Name
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Signature * Please comp a ce statement on back of permit** Signature
400°° 3 j4a 3/s/q WW/q
# IssuingDate Expiration Date
Application Fee(s) Check

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT ^
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I hereby certify that I own property adjacent to C a a 'l �'-_ f c 's M
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property located at F604 ,c1,10,tivfec1
N (Address,Lot,Block,R99aad,etc.) N.C.
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to (Waterbody) (C /Town and/or County)
0 The applicant has described to me,as shown below,the development proposed at the above location.
o 1 A,ti f J I have no objection to this proposal.
E Q I have objections to this proposal.
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DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
as (Individual proposing development must fill in description below or attach a site drawing)
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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 setback, you must initial the appropriate blank below.)
It
I-!t�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)
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✓ Pant or Type Name P or t!P R V/v�
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cn Mailing Address
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City/State/Zip
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✓ Telephone Number • 1 Z- 3 i
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C7 ADJACENT N N RIPARIAN PROPERTY OWNER STATEMENT I hereby `v
y certify that I own roe ` —
ti property rty adjacent to v l((�,c tm tt r G, ' s
property located at �'�"� `5`�j '�t�� (Name of Pro rty Owner)
on t �1, ` (Address, Lot, BIoq, Road,etc.)
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Waterbody) ')1 �2 lk N C.
aqi (City wn and/or County)
b6 The licant has described to me, as shown below, the development proposed at the above location.
✓ -
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t I have no objection to this proposal.
I have objections to this proposal. i
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co F DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
t (Individual proposing development must fill in description below or attach a site drawing)
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WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
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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.)
UM— 'I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
t
(Property Owner Information) (A 'a ent roperty Owrer Information)
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Prri}nt or T pe am Print or Type Na e+ (�
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Check
Date Received Date Deposited' Check From(Name) Name of Permit Holder Vendor Check Number amount Permit Number/Comments Receipt or Refund/Reallocated
Column( Column2 Column3 Column4 Column5 Column6 Column7 Column8 Column9
3252019 'Susan Taylor Susan Taylor TD Bunk 3142,1 400.00'GP#73550Q iPS rot.7954