Town Of Swansboro

®C VIA / ❑ DREDGE & FILL /(, V '� / T No. 74940 Gc
&H VERAL PERMIT Previous permit# A B D
1_1Fmf ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued l
As authorizecl by the State of North Carolina, Department of Environmental Quality /
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / ( [_-
❑ Rules attached.
Applicant Name t-- C, '�/ ../ ./ r^., Project Location: County 1, r%
Address 4 !'' �_ ,�' f / t - r l Street Address/ State Road/ Lot #(s)
City State N� zip
J�
Phone # O ?! S, r (E_Mail Subdivision /
/ r
Authorized Agent
Affected
AEC(s): ooEA
ElPWS
ORW: yes / no
F❑❑❑ EW PTA ES PTS
OHHF ❑IH OUBA ON/A
PNA yes / O 1
City S - , ; - ZIP -. I J f
Phone # ( ) River Basin
Adj. Wtr. Body { = 'rt- .%c of Iman unkn)
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature *• Plane read compliance statement onback ofpermit **
Check #
,l
Permit Off— icer's Pi' dted Name r
Signature,.
Issuing Date Up ration Datel

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1.0 Win 6-t- s
(Name of Pro erty Owner)
property located at �;,A SA , 5yre-<-� �Ytcl �o GA
(Address, Lot, Block, Road, etc.)
on Wrxx� Oat! f-4cr BgS In in S• u a n S� ora N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loop'ion.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Ize Pair 4'0 rt CCd re pla«d .: L on9
.f �y„(1 161 lb0GY�
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 yBou wish to waive the setback, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Owner Info mation)
or
Telephone Number/email address
S -1 to` 2 oro
Date
(Adjacent Property Owner Information)
Print or
'71V"JGfp'YIJ I
Telephone Number/email address
5"-!S 10l
(Revised Aug. 2014)
`Valid for one calendar year after signature`

GoMaps
May 20, 2019 1:500
0 0.004 0.008 0.016 mi
0 0.005 001 0.02 km
2019

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1r oow g p S wA„a$ sac, 's
S}��e} ame of Property Owner)
property located at Kore S 4) tt(NJ0e 0 L—
(Address, Lot, BIQck, ��GRoad, etc.)
on While.. 0+�4L Rarer sca—,in Asbct.re) N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc Ion _
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development Must fill in description below or attach a site drawing)
�,epaic 4o `C )oc,r-o ((owtvt� opr�
1 V Q. o
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
(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.
party Owner In ormation)
Sygnature ��
0 U✓�A G+.r lU•,I
Print orC Type Name
/n0 t ,,',-,sa ,ae Pa¢,
Mging Address
"'ov161�o1u W- 2)l5'StU
City/State/Zip
tn• 32EZ6c�c�
Telephone Number/small address
S-• 1(n •- Z o �•y
Date
,.., `Ju
Address
City/State21p � 0 '(' /� f-zql
Telephgn � y� emsail addres i�P/
Date /* /
(Revised Aug. 2014)
JANKrl. �\
q-L C
*Valid for one calendar year after signature*