Kale, Charles

gg� M eAA / f I DREDGE & FILL r h - NO. 75213
F,ENE;iAL PERMIT Previous permit# A Bc ; D
I ew ��Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized b�lthe State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �L/// -
t ' ❑Rule attached.
Applicant Name ( 1 1'. , I all,k � t / Project Location: County ( C_"
Phone #I I „c-',ail
Authorized Agent 511
El cW
Affected
EA
AE1-1C(s): SOPWS
ORW: yes / no
JEW ri PTA [I ES ❑PTS
❑HHF -1IH ❑UBA ❑N/A
PNA yes / no
Type of Project/ Activity
Pier
Fixe
Float
Fing
Groff
Bulkl
Basir
Boat
Boat
Beac
Othi
shor
SAV
Street Address/ State Road/ Lot # s)
Subdivision
City ZIP11
d �l.
Phone # ( ) � Rover Basin . fll ! /
Adj. Wtr. Body
�B' 'rrL' J61. nat ban' unkn
Closest Maj. Wt.. R_d, < i5t' 'i 1
(Scale: ��Q ( )
■■E■■■E■■■■■■■■u■■■
■■■■■■■■■E■■■■�
EMNON
■■■■■�■■■■■�
■■■■�
■�
■■■■
M
MEMOS
■■■■■
SEMEN
....
■
CC■■■
■E■■■■E�E■■■■■O■SME
■MONESEN■S■
■SS
ONEIM■�CM■■■■■
ME
ME
SM
■■E■■■MM■■■■MSOM■E■■NISI■M■MEMO■■■
■■■■
■EOM■■■
!�■■O■■■
■■�i■SSt;tl��ju■M■��■■■■
no
mom
OMEN
EN
�iAF■1�iiC■MCC<!r
+NGii�Slt■.�mCCCa
■E■■■S■
11irIS■IIS■SiM�■i■■ilE■■■■NIM■■■
■
■M■M■ENMS
MEN
■■■
■■■■MO
ENE
■OM■■MM■■■■MOO
■■■■■■.■I
mom
■S■IS■■■ES■MM■■S■■MMM■E■■■.
CC�CCCCCC�SEEN
CCCME
AmICIIAI
�CI131E
■M
■■■EOM�N■E[S■[/MOSMEO■
WEM■/JfiMfiM
■■■
■
•■•
•••■...■..
M
CIIIIE■II
CICCCCCICCI■
IICCICIII
CCCCCCCCCCCCCCME
No�
E
CCCCCC
■......■SSMM■■■ENE■■■■■C......Ed...■..■
..■■
■MEN
mom
CCCIIIIII�IICICIJINEEM■■I
.■.
..■■
.■■.
.■■■■
MEN
...■■
M■■S■■
■■■■■
S■
..■.
.■■
■
■■■
■■■■
M■■■■■■I■
■■.■CCC■■
..■.
■■SI
■■E�IME■■CME■■■■■EMI■■■■■MS■■M■■E■M■o■I.
MEN
No
mom
MEMO
M
CMENEM
S■■SS■S■■n■S
ME
.
�...■
:■I■■■
IECCCCICCCCCCCCCCCC■CICCCCCCC0
Nis
1CC
CCCC
Mo
Phot
Wai :
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
❑ See note on back regarding River Basin rules.
Agent or Applicant Printed Name - Permit Office intedNme
Signature**Pleaseread compliance statement onback ofpermit** Signature
Application Feels) eck# Issuing Date i E piratiorl

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Cu.A1L�,-C-S o. \k.ALC
Mailing Address: Sooty I-IoPE vzor"'[�'
lN►NNSC3orLb, cC 2-giBo
Phone Number: 12)03- q2o- 3(vl 8
Email Address: 'DoN6 Cc"
I certify that I have authorized '9 C-Kr(L-Li gkodkS
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: SG/% W NL'L- 'Do CIL
AND D2C-UGtNC�
at my property located at 7-06 7S(-.JN\FC-t- D(,IVCt 4AKVERS 1SU4►JD
in CA2'rEfLE-( County.
1 furthermore certify that 1 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.
Propert Owner lhformation:
Signature
CIWVFS o, kaLAC-
Print or Type Name
Pf-dP(,9--tLA OwK)C-f-
Title
7-glZdl9
Date
This certification is valid through -1 / ZY / 202O RECENED
JUL 2 4 2019
DCM-MHD CITY

0
J, fY P✓l fa n C(Q e'JiNNe 1-
ffe,fe5:
TjpU[J KAh e !1?03eC�
�EtYIY/�rt'R pR.
j•Fn�KcRs Tslre.
B_ 'pAcpdSQ
oy Wlyyy aw4R F /
L _ oAoSe 8oA f &!A
�// /�� TR�Ckocl •�
dRQc�eec� SPo�1-S y�lz
C AA1d CIAO
� iKS/n/l ��ntnfg
PPPO9 e fe p
,JAo A' at e,Vel OT
Mpf2-gA
i
1
49les r /69afIll )�,4y
RECEIVED
JUL 2 4 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to C1-bA2LkS k ALE
's
Property located at 20 (o (Name of Property Owner)
-VNIFC� b�%\%(-
(Address, Lot, Block, Road, etc.)
on Wrc-%-rMOV714 gAN in t-1A2Kc-iL9
(Waterbody) , N.C.
(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 till In description below or attach a site drawing)
< A-rrACgc-I�' �>
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.
v ,..N-,.y v mi mtormauon)
to
�CI4-a2u t D. YAID
Pnnt or Type Name
SooU 1-►nPE.- Peen
Mailing Address
_WtNNCFtn?n SG 2GIIbo
City/State/Zip
603_g7-p-ZIfi
Telephone Number/email address
�uw 2y . 2.0Iq
bate
*Valid for one calendar year after signature`
(Adjacent Property Owner Information)
i zaturv*
IP/-ivy � L-e���ovtS
Pnnt or Type Name
mg Addres1
. I ' A X Jam/ e 5 9
Date*
(RevisedAug.Adji)07 2019
DCM-MHD CITY