74111_Jerry Goodman_20190822

i: et": AMA/ ❑DREDGE & FILL No. 74111A T
GENERAL PERMIT Previous permit# ^/�A
> Z ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued p//A
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 5A NCAC C17 it 12 0 0
El Rules attached.
"Applicant Name :37- ��I/� Gd ofl,t)Ai Project Location: County 1.2AMLic a i
Address G 0( F Mil 1 r IA C >f50/) e.0 Street Address/State Road/Lot#(s) f 70 (,./l Si:
City FA ISO dState /A. ZIP 2 c°)J(1/ CAn/iL 0'I fiJjAL
Phone# (Ili ) -73 - )9t Mail Subdivision 2 I/1A/r_...,
Authorized Agent !3 �[� � S CO 7r ivy),I n 0 rjl� City 11:/+/r/4 L ZIP ;9$ Y /
❑CW � A ❑ES ❑PTS Phone# ( ) River Basin ^l C If 5l�
Affected ❑OEA LJ HHF IH ❑UBA ❑N/A
AEC(s): Adj.Wtr. Body C A API 1....-- A aS s/man /unkn)
❑ Pws: C ei
Closest Maj.Wtr. Body i�AW 50 l 1
L: ORW: yes no PNA yes /47)
I
Type of Project/Activity A i�Iogiu 0 j3 /1 i3 / a0,4T1 If I 4 LIYI 6 ' /9/4 7.c DX' r
(Scale: 1: p i )
Pier(dock)length 0.7
Fixed Platform(s) 14 X it) / 1 Ij (
Floating Platform(s) AI—
Mid__' I. .. —Pl�ai� .......
•
Finger pier(s)
IIIAIi1iilIII
IllIlillIlI
Groin length ``
i f
number
Bulkhead/Riprap length `•'� MEM ! ■■. . ..j1...1 No mammy
•.. : Ir.
avg distance offshore f j �
�I
max distance offshore ..� �
f
Basin,channel j
11111111
cubic yards
ti
111111
Boat ramp I
II 1
Boathouse/410P /1 J .®.. ...ilim.. rkumgai � ..:......
Beach Bulldozing MI.... III
t---1.� 111p 111.1U®oC.111...
Other ".-- !'�e��.��...�
1__ 1!I/, 1143 5i i 11111=:::111111
_ I 1 IIC 1111101111111111111111
': �'. ..
I
Shoreline Length t 00 I III ill
a I
SAV: of sure yes no t
fl 1IHHHI1111111111
' Moratorium: n/a yes �
Photos: yes ' ... . .. --- ...= ...._- .. _ l ..
Waiver Attached: yes ( i i fi 1 ' 1 i
A building permit may be required by: /\PAL 1 C 0 C O U,✓T" . I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) _.s,.
Notes/Special Conditions SC f 07 0 )t 0 0• g 4( /
1I r
iu
6,,a, elkAial ,..---
rEvIAJ pAre I
' Ag plicant Prin ed Na Permit° r ted Na
0 Iiik"61111/4'
Sign Please read compliance statement on back of permit** Signature
NI '.9dz `i t z ALA (' COI/ e 2 nfc Za/mil
Applilation Fee(s) Check# Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: j
�� VG70o6, h(vky\
P
J /� L
Mailing Address: / Y/ G l o m / 7 J ( c()r) O
Fa Lf or) I Al( ,g83' l
Phone Number: qi9 - , ,J 3 11-8,5
Email Address: �) /1�- '1�2
I certify that I have authorized D. SCDt Ma r/r c Qj( -ivi(C-/`/r ,
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA p
ermits necessary for the following proposed development: o 66a /(
apci /7,4 siii,- -------.6(_
at my property located at 77O IU(Sc 1-il ., O r/cri
in ? (O County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
K—_, : 72/
Signature
Print or Type Name
Title
of 1 3 I 1i
Date
This certification is valid through Q / 8/ / 2O

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
r i'.efeb_.c-�?'if .'la: I.al.T: mper:✓adiacent To J e.rr• Ci cod tnah
'�]/� ,A ;c p Ln (Nam of Property Owner)
piabe-ly located at I I LI M lJ V •
s ( , o Iock. R d,
�,n Taan S �ec ressn __L oji
iWaterbody) ICityfTo ndlor County) 1
Tr1ro apoi c::3rt has cos:-ibec r:.a. as =t-;�;;01 oelow. !hc . u;.:.:OpirclIt - epr:sec: at the above
lu::a'_ r/.
-)a4e'10 t?I?jt.''t.1.2n is;::.1r.*Dpc_.,11.
nave o3 edicns:r this rnr,a, i,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(tna vidrtal proposing devctepmevrt must fill in description below or attach a site drawing) t ,t ,
/
fif,-_--1-
�`Y ! ; WAIVER SECTION:IDN i ;
i Lriderjtor..:1 :iv.=; :J `.icy:k_ In:x:311: F Imgs boar. r:jrp. 3n�.--Zkv e . i':•43 _':ot;_ie i;t�i, or i,-:1n
rn,I{ distance zre_j Of le b.
t �C-:'sCt :;%3L!(c! rF:ir;S.:rLri dim an..e a- 1';� Tt,,l my a:w .�cit lcu .a...-.,_.... �.:r ;_5 is'�:"L;�' v
m ;I yOL_ vir h:o l•i3^le the setback you`must initial the 33pr"'..:ia e. blank below.!
I :id wish to waive tie,.S's011ta.ck- sirrner:t.
I do notwsi o waive:he 15-settac req errent.
(Property Owner information) SAdjacent Property Owner information) 1
.....17 - _ _ - t
-AI .1. /is I_ I lig . '' s'i4ori
.c-11,74-lir :y..-..?...P.;.•.-p7,T .L'a'...1112A0 . arkt eitt RjOaCi
::::,..„:,..,,a
j le fel i 4001J1ple
C<,;--v....i,v,�1JTP os,.:_..r3'!ac: r!_$:C �C:4`GC_;..E..".';':."r t:;eME1?t7:L.roFR
rail itoAA
.,--r..s._ -,
e-'3 for brie_a ero3r year alter s.cn?'_.•'• .

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i efery_.t»'lefe ltiat i own ='D/F`�=r^J adjacent Cal
____d_eerr
pio:;e-ly located a
` �V W iJ V 1Nar�'1 of Property Owner)
( ress, Lo iogk,R- d,
z.rt � ei `s C�ec ari atp,.oetIicoCo.,�.-,
fWaterbod 'City+iowdlor County)
Y)
The apoi cart has .._striDec tz re_ sS;'th,,J'1 36.10.,w. tt .+.: ::ioprt_:!t .. np:-..se; at t*i-: above
IoC.a? rr.
Xi --Izav;no ot.*L:-�'1 its .: plop:al naJe ob:;eet7ons tb this pr^:.07.431.
DESCRIPTION ANDJOR DRAWING OF PROPOSED DEVELOPMENT
(incrividual proposing devotopment must fill in description below or attach a site drawing) L t ,
t a ) l r__t f.i�t
•
s _
�.yt.._tea.....:
•
. a
1—C1.:1(k ‘C‘i
p S
II/
I 1'Y r WAIVER SECTION i La.
I T.tderstir'. :'tit a ::t_:. i:..�:k_ itco,ins phrigs boa:: r3r''p, 3-`rai:w-a-',e. L`::.1a:`.oi.:'e. 1:-h or,r;r
m 1$t Lte set oat:4k c! rr m- rf distance O' 17 T�.-1 my :re.4=1 . `12.-aria ia- R::; 3a urije-^ ti[' :"s
t.�:r. Yi::9
711.. '.f yoL virah:o v a'.e the<etback you must initial the abo 'fate blank below
I do wish to waive:'le 1 solbr L;k=Mur.r;ert
- I do not v:r=_7 to wane he t E setrack r .;i's-rent.
(Property Owner?reformation) `Adjacent Property Owner lnformatiOn)
It 'T:. ji _ 1iti:f7.Y. :-.,, t!:i :il: YSi'.:,i
tok/CA,7 -/A/c- a5.7/
3�
_t :�,L. s=oa:.=' ;.3 —Y7
:1YL:r..I:.:'Numbs,—f e: e..'S?fdre.55 c'ecr:_�•_''i;i*"'c i error.,!ed re
"VI; 3 fo_.r ore _rear year sre•s.cn .._*e'

Applicant: Trg ‘( G C G 2M 1 "
Date: a7 Z 4 U G ZOI of
General Permit#: �L/ j I I.k
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 final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
`a-f `a' 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)
?'f✓ L rw, Dredge ElFill❑ Both ElOther ❑ 2y 2I- 2 L/9I: 7
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 El
Dredge❑ Fill 0 Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
f 3
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