74137_Fredrick & Paricia White_20191210

416,17‘CAMA/ 7 DREDGE & FILL i.t 4 co Li- `14 1 No. 74137 . !! 10 C D
G NERAL PERMIT Previous permit# /t
>c% V ew CModification ❑Complete Reissue ❑Partial Reissue Date previous permit i ued pp 1
As authorized by the State of North Carolina,Department of Environmental Quality 2 ODO
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC d )1.
attached.
Applicant Name FKf u R)L Kit PA f&IC l A IIA)F/lit Project Location: County l pA A t i(1(0 ('d V4T/
Address 7 5"76 j?of'LAk( v Street Address/State Road/Lot#(s)�A/4E
qp
City F f State ZIP of t7 l
Phone# ( ) E-Mail _ Subdivision
Authorized Agent . Tr1)4e Q U'0(e V 1/1f.. S 7> City fv/fRIt I T? ZIP 2 RPL
11. ❑CW ❑EW p4 TA ❑ES El Phone# ( ) /�River7 Basin ACO w
Affected ❑OEA ❑HHF D IH ❑UBA ❑N/A /unkn)
Adj.Wtr. Body 1 GGs' t� �`. all, an /un i
❑ PWS: Closest Maj.Wtr. Body g Ay P(✓et'
ORW: yes / no PNA yes //�
Type of Project/Activity /`i fl c)(II e rJ (i) Si I P (/i ''1 / / 1 U V 2 (2) Pi(i^l G r
(Scale: /':30 i )
Pier(dock)length — i
Fixed Platform I s) ) _ �J'
Floating Platform(s) r — �� i NINI NI• ' •••• •NI
Finger pier(s) 1 ' i 'liI!liIIIIIIII
Bulkhead/Riprap length ... .. 1
avg distance offshore 'I11 ` I iiiHuiIIIIIHIIH1HHHhII
max distance offshore ■••••■•■
Basin,channel — iirjiiiiF !'iiIiIi!iiii
cucyards ,:
Boatrap '
,
Boathouse/Boatlift " a�•••���� �� i � M I
Iii
1111
ir _I _...I-MINI__.Irmo1 1 ii
Beach Bulldozing i � En
Other,,, ,3 7( fl$, i i :111miiiirli��!till
�_
.1 / EMU! ■■■ MINI. IIMITHM11111151%,1111�Shorel
ine Length �QU �...�.... .L.' (SAv: Yes no CICCIIIISSNIi ll IramirmiNI
Moratorium: n/a yes no , MII ■■IIIIMIIIII .IMIII...IIMIII...®...
NININI
Photos: yes el . • ' '_ NINI.NI MINI •••• MININI r w • MINI..
i
Waiver Attached: yes
A building permit may be required by: P/AfilL I C 0 Co 0 An"/ . I I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)Notes/Special Conditions ..5C[ 071/.ZG 0 6 c I r-ti 0l g ,-5 i I ,
KEV IA) tiAgi
—Agent"�� Permit Officer' P' ed Name
Agent or Applicant rinted Name
S nature **Please read compliance statement on back of permit** Signature
i1Z00.Oo /03 I I o DCc )oft lb Apntc 1626
Application Fee(s) Check# Issuing Date Expiration Date

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
r" )
Name of Property Owner. weed,►�-it' - c' , v4 d,i`ei ti 421 L14
Address of Property: 7s-7& ye' /?J 04.€in*` I X. 8 55-6
(Lot or Street#, Street or Road, City&County)
Agent's Name#: 9 /— Mailing Address:
Agent's phone#:(r -sue' 9r'`/ -- ttisy
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
(see. AticeduAttat A-
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed,you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
(PropsOy/Owner Information) (Riparian Property Owner Information)
filf.-
Signature Signature
,frie:i)L-h?i6 ?DA / F, re_frt;t t-C{
Print or Type Name Print or Type Name
11// k7ViW Le- A KD. 7307 Alre*Lite ;
2-d
Mailing Address Mailing Address
City/State/Zip I 1 City/State/Zip
,` .-11153� 771L
Telephone Number/Email ddress Telephone Number/Email Address
��� �i` 11/ 71>?
Date Date
(Revised Aug. 2014)

COMPLETE THIS SECTION ON DELIVERY
❑Agent
SECTION A Signature
COMPLETE THIS ®Addressee
•
SENDER: y ;"?��-��;i�
�,2,and 3. A.
C.Date of Delivery
Complete items on the reverse printed Name) t
.� comp a and address g. Received by� A Yes
Print your s card the card to e myouall piece, I,b I(Printed
item t?
so that a can return of them P different from 10 No
to the back address address below'
this space permits. D. Is delivery
• Attachif YES,enter delivery
or on the front if
yt�Cie Addressed to:
Fe_'r -r
`'� L e Express®
n �v f �� L� �J✓ P`e isle AIM
lsin. r Yl 3. Service TYPe ❑R g. FAail Restricted
CI Registered
0 Adult Signature pelivery Delivery
Signature Restricted for
'�"II'I II'�I"�III II'I'II Adult Sig CI Return Receipt
Mal® Merchandise
Certified Mail Restricted Delivery
II"I'I'I""11111 Certified 0 Signature Confirmation'
4546 8278 9p17 63 ❑Collect MCI Delivery Restricted Delivery Signature Confirmation
p Collect Delivery 9402 t on D Restricted Delivery
9590 Mom' pelivery
991 Mail Restricted Receipt
2 Article Number(Transfer from
service Isbell 2 ,,,00) Domestic Return
?p18 309� 0�p1
54?8
nni Pi PSN 7530 02"000 9053

i rieu wniie give
Steven Quidley
permission to obtain
necessary permits
on my behalf from
c . a . m . a . 12 :, P,,;

Applicant_
Date:
General Permit#:
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. I FINAL Sq.Ft. I TOTAL Feet FINAL Feet
(Applied for. (Anticipated final (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
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)
o Pir/ U/rx(I, Dredge ClFill❑ Both ElOther TZA ? I z / �r
Dredge El Fill❑ Both ❑ Other Ell�
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill 0 Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both El Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge El Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑