Chappell, Ralph

CAMA / ❑ DREDGE & FILL No. 75224 A B C D
1C9NERAL PERMIT Previous permit#
hi' -New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Res o rces Commission in an area of envir nmental concern pursuant to 15A NCAC # j
/ / ❑ Rf les attached.
Applicant Name r 1 i L ` 4; 4�p , � Project Location: County (_ /
0 { ��? - /'/ ; - // Street Address/ State Road/ Lot #(s)
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State 41( ziP�1,i.
Phone # (j_)C)) /� //-
Authorized Agent
AV
Affected CIP
AEC(s): DOEA
❑ PWS
ORW: yes /rno
,OFW •t�$TA ❑ES ❑PTS
❑HHF ❑IH ❑UBA El N/A
PNA yes /11no
City ( II ZIP r `,, &
Phone # O River- Basin ` •�j
Adj. Wtr. Body " "' / ` I ' , I 'r (nat man unkn
Closest Mal. Wtr. Body f � < < i� i
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Agent or Applicant Prr ted Name /
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Signature*[`Pleasereadcompliancestatement onback ofpermit"
Application Fee(s) Check#

HuIJ Iv mIrMRIH1V rmwr Cm I 1 VYYIVGR O Im I GIYICIV
I hereby certify that I own property adjacent to RAI iN f • uplKLL 's
/� ) J (Name o ropert" 0 ner)
property located at SI02 I�ROv> F} 11 �OM> �rAll P-i K • A l�v
(� (Address, o Block, Road,
n )
on l�Dcu� 61 in ('�N.C.
(Wate body) (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 fill in description below or attach a site drawing)
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-tr1E �tR£ 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.
(Property Owner Information)
A I g-. rd'!y
Si tur•e
M00,11 e . CNA�p6c
Print or, Tyge Name ,f ?D
M97,4ud%n� fl%
City/ te2ip
(X3�7/- Telephone Number/em t address
Number/em t address
t�APPe�� yA Itoo •LD?
Date I ^ l9 -, iR
Signature*
Print or Type Name OW
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C'izl-E6
Ma� gAddrehat) ���
o�
City/Sttattee/Ziipp G
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2 �/
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Telephone Nr_ulmb r
m`>ail a
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d Crews
Date *
(Revised Aug. 2014)
*Valid for one calendar year after signature* RECEIVED
AUG 03 2019
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONAMAIVER FORM
Name of Property Owner: RlPrte E e1 �l�l�u- CC'l�t2t\
Address of Property: V2 -bc0us 4' a Wh/4— Iye oL r� JI
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Mailing Address:
Agent's phone #:
I hereby certify that I own property adjacent
applying for this permit has described to me a
I have no objections to this proposal
s
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 littp://www. nccoastalmanagernenLnet/web/cm/staff-listinq 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.
(Property Owner Information
Signature
/<ALPO egAPPELL
Print or Type Name
96 Z dpow //// 20�
Mailing Address A� /
�tQuY001 AIC-?8��,L7
City/Sta ip
69#07-AEO,yAPp" L(�,y-911400- aw
Telephone Number / Email Addre&s
7-/9-/9
bate
(Riparian Property Owner Information)
Signature CROW hLri-L
C'N&eL E
Print or Type Name
7s� Oko w g ll
Mailing Address
>;F+NFOG2r nI e 28S1�
City/State/Zip
,qECEM9pQne Number/Email Address
AUG
teglq
DCM-MHD CITY
(Revised Aug. 2014)

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USPS TRACKING #
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III I IIIIII�IIII�I�IIIIIIIIIIIIIIIII 590 9402 4859 9032 8403 43 I
United States • Sender: Please Print your nameaddress, ess, and ZIP+
Postal Service
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USPS TRACKING #
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9590 9402 4859 9032 8403 36
United States
Postal Service
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First -Class Mail ,
Postage &Fees Paitl
USPS
Permit No. G-10

■ Complete items 1, 2, and 3.. '
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this cars to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Q4N,gaLi5 zFF,A0
Sob tvoofl��t,� J7Rt�c
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Agent
X / `� ❑ Addre:
B ed by Printed Ar C.C. ^Date -of Deli
D. Is delivery address 6ifferent from Item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
Service Type
❑Reglay Mail r s®
1111111111111111111'�IIIIIII
IIIIIIIIII
III
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❑ Adult Signature
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❑ Registered Mall
❑ Adult Signature Restricted Delivery
❑ Regisland Mail Ream,
9590 9402 4859 9032 8403 43
cerniineed Mel Restricted Delivery
❑ Reltum Receipt for
❑ collect on Delivery .Merchandise
Collect on Delivery Restricted Delivery Cl Signature Confinnatlonn
_. ❑ Signature Confirmation
2. Article Number (lians(er from serv/ce label)
7017 1450 0001 7599
4361 tad Delivery
Restricted Delivery
•- PS Form 3811, July 2015 PSN7530-02-000-9053
I
Dome" ftp 'm Receipt.
m
■ Complete Items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece -..
or on the front if space permits.
1. Article Addressed to:
507 MBE SET
e,Apq�/�M, lie •a�2S3
II I ��I��I III I�I I IIIII III�II III �� I I I �� I � III III
9590 9402 4859 9032 8403 36
If YES,
7017 1450 0001 7599 4354
pS Form 3811, July 2015 PSN 7530-02-000-9053
JUL 262019
on Delivery
on Delivery Restricted Delivery
doted Delivery
❑ Agent
Restricted
Domestic Return Receipt

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property: 0& Z 6POa #7//
Agent's Name #:
Agent's phone #:
(Lot or Street #, Street or Road, City & County)
Mailing Address:
I hereby certify that 1 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.
�Q- I have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, you mustnotify the Division of Coastal Management
(DCMj in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htta://www.nccoastalmanagement.netlweb/cm/staff-listing 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. RECEIVED
I do not wish to waive the 15' setback requirement. AUG 03 2019
(Property Owner Informatio
zrt.
Signature
plll.Pfj C . C'HRPP€�L
Print or Type Name
819 z cRow II 2wllc�,
Maiiing Address
J?64U<a2T NC o2�.A
51ty/state2ip
(33&� (o ) —.5-kv
Telephone Number / Email Address
C AP i REcHA?�eL_ @yMA0o,01
(Riparian Property O ner In'f)ormation)
Signature
'DEAN (z)�,14Z Lei 6,0
Print or Type lVame
5017 49EC Y REE-r
Mailing Address
C' k\�Atk , V� C o?7253
City/State ip
Telephone Number/Email Address
-7
l — `q _ I J Ilate
(Revised Aug. 2014)

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