74171_Donald Jefferson_20191028

0 2tAMA/ ❑DREDGE & FILL ZO 4- I Y1„11 V No. 74171
GENERAL PERMIT ``t�' b l Previous permit# ,y/A C D
> C'Jew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 SA NCAC U 7//. 0-00
2 Rules attached.
Applicant Name /2 /a JCI: e is N Project Location: County ffP_rN 4. t
/v
Address 3 t/ .,J o S c �,� s) e// D,, Street Address/State Road/Lot#(s)
City irel/ ✓r4., Stately C ZIP 7J/G
Phone# ((/?a) VSV" CO`y) E-Mail Subdivision Rs-s- o -52/✓e /
Authorized Agent 1 rf(-y ,, ,;fr. City ZIP
Affected ❑CW C5'�W FrPTA ❑ES ❑PTS Phone# ( ) River Basin /a. /' a el
AEC(s): ❑oEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body P4-'i v 1 v-4'r 40 man /unkn)
❑ PWS: Q
—, Closest Maj.Wtr. Body ! U.) I 'v el
ORW: yes / no; PNA yes no
Type of Project/Activity AL, /II.-, ze /7 ' /, ' 66s.t /-4. rr i,kf s ��� we / f/2
i (Scale: / .'_ 70 ` )
Pier(dock)length \ _
Fixed Platform(s) �Floating Platforms) � Ma- M
Ill -
Finger pier(s) ®111=1 E11111-111111/2
Groin length aaU Ia M a•�'
number ®_U �I e 'i `f�IN _
Bulkhead/Riprap length IIIIIIIM�;�
P P gt 1111111111111
�•_
avg distance offshore UUU
max distance offshore USU
Basin,channel / MinlanillinillIMMIIMIN
®— —•—
cubic yards U- 111.111111.11
Boat ramp ®_MISEIMI �_
Boathouse/Boatlift /- y/� immi■■� , j M
l � �, .4 6 rill
11
Beach Bulldozing �_— Tay o r e■rgaimi a�NP � IDI Other �� �_I� ''i
mimmummarmisaimorm
III
alIMINIMMINIMMUMIllal
Shoreline Length M
merzu 111111111111111111•111
SAV: not sure yes ral _ INIMENIMMIIIMIE__._.. ._..___._.__ �=: - ---
Moratorium: n/a yes no _UU
Photos: yes no i i _
M Waiver Attached: yes no / / —UU
A building permit may be required by: rCic,t 7 �- - ' 6.�Y. IVrSee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions sir" 0717 w?06/ I ,' / 6,, a 77
....c/I G c ..J/ -e
Agent or Applicant Printed Name-- Permit Offi is Printed Name
Signature '*Please read compliance statefnent on back of permit** Signature
'''1 ..;.---<",'c_.-/C2 — 105//9' ,,,,..2/.2,,,e-A
Application Fee(s) Check# Issuing Date Expiration Date

,.,..... 1 ;=;,:i}ARIAN PROPFRTY OWNER STtIlt1-
. r r T ' il-,/.7-41`7
0 c)perty adj )acent to '61'4,/-} / _ _ -j_________
(Name of Property Owner)
,,, ) ; e •-
,-''- ' i AI it' SIV lei" (-I,2:.;J: 7`4..i-:1-1 1 if 1.--41.
(Address, Lot, Block, Road, etc.)
in _2 fitdi.) 6--''' . N.G.
- - — (City/Town anchor County)
, , -.-%•C LI to me, as shown below, the development proposed at the above
niii cAlection to this proposal
,:,::!ve objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
1 r a w m 17
(3 f
t
I :1
O''i• ' ' 1 )f I/
_
\,,LI -N-----------
WAIVER SECTION
1 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.
rim(Pperty Own Information) (Adjacent Property Owner Information.044die
i . )
.____T.
Signature r Signalyre*
' idtf lk.4 a iffiz,----AsoA,
Prigt or Type Name Print or Tipe N-atne
4417 P Oa iTiaL6 7),(VE
Mailing Addrpss I ,
Aktglift-Al NC 01967/ li yaiting Address
7' 7 i ti
City/State/Zip
_____ citkistawz __
o • , __ r_..,
Telephone Number!email address __...._
D
OCT. i>101 ? Telephone Number/email address
Date 4 -
'Valid for one calendar year after signature* (Revised Aug. 2014)

I
Lli,iiiticatiTAR 'RI Si P' P -TY W -: - S E r-,:j
I hereby certify that I own property adjacent to
;) (Name of Property Owner)
property located at i—or ;t6' 7 _ it(A/.465110_ k2--:-4`
-(Addr s, Lot,iilock,Road.etc.)
onp... „ q
, rx_,vaA, _ , in____/16 A / - 1,7 4 P . ‘4, _ , N.C.
'-'-' (Wetorbody) — (City/Town and/or County)
Me applicant has described to me, as shown below, the development proposed at the above
iodation
_ ii<__ I have no objection to this proposat.
I
_ have oblections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
f 1
1 9 .
•• f
I il k
R i
7 _-----------;" 6 - :
.--i •4'f'
t7,-,,.,,;;;NER
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, iift, or growl
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 16'setback requirement,
- - - oga....i...WeNeWa"....201illarnimM
( roperty Owner Information) (Adjacent Property Owner Information)
_.-
„ • 11 _ . ., --
A=,/tiliv.i trts:v.J (-• 4- ,:>.4L,
_, _ ___ _ 0A.,-..-- , -
Si (z. 7 tfit'4 S()AC Signatvre*
),:!'' t1 ._. e_(4. 1-17-ri_ftrift-f--)
Print.or Type Name Print or Type Name
GI .... 6 i•I_.4 11£1< iii4t-r v\4051.
MuliiriO Addroas Melling Address ::
111114Yfrie AIC -4987,..4
",',...._-. - ,...._ -LA_ic,:,_O 4 12.c_ t,I c,-- Z -7 S"
(Ay/state/zip btyisi4pizip ' --
177 rit S 4- KO 'T-.3 ici 1-- Cic
..
Telephone Number/email seeress Telephone Number/small address
_,/,,
Dare Date*
1
1
!Revised Aug. 2014)
'Valid for one calendar year after signature*
i

AGENT AUTHORIZATION FOR CANA PERROT APPLICATION
Name of Property Owner RimpiesUng Permit r;t)
Mailing Address: 3 1-,c- Pit.045-0 c_clA fte_s
j4JrC .
Phone Mabel': *1. F*4-5-4- B75 ti-3
/00 Z-Cli a 0 7 rn A , Le) 'Nfl•N
Email Adams=
I certify that t have authorized
Agent/
to act on nvi behalf,for the purpose of applying for and obttinbig all CALM permits
necessary for the following proposed development
igegf
at my property located at Plj-/T9 -CAor ,
in 431e411- Comity.
furthermore certify that I am authorized to grant, and in fact grant permission to
OW Won of Coastal Management staff,the Local Pen,* • ; and their egenft to enftr
on the aforementioned Lands in.connedion with evaketirg inionnedon relabx1 to this
porn*application.
Property Omer Waw =
Printer Type Nano
u) AJeJL
TVs
/6 1- c71)14?
Date
This certification is valid throw:0_/6 aoa-b
•
_ _

NC Division of Coastal Mgt, Habitat Impact Computer Sheet
Applicant: /0 < `GI /� vlas.
Date: /pl.2-tp/is
General Permit#: 7q, 7/
Describe below the HABITAT disturbances for the application. All values should match he name,and units of measurement
found in your Habitat code sheet.
TOTAL Sq. Ft. FINAL Sq. Ft. ; TOTAL Feet FINAL Feet
(Applied for- (Anticipatedfiinal (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Habitat Name Choose One includes any Excludes any total includes Excludes any
anticipated restoraticn any anticipated restoration and/or
restoration or and/or!ern p restoration or temp impact
temp impacts) impact am cunt) temp impacts) amount)
r Dredge❑ Fill❑ Both ❑ Other lEr 'a""4 v �7
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other •
❑ I
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
i f
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑ j
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Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
I I
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑