Downing, Greg

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®E CAMA / ❑ DREDGE & FILL No. 75064 A B C' D
GENERAL PERMIT Previous permit#
ONew ❑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 15A NCAC
[*Rules attached.
Applicant Name G\ ` Project Location: County '1 ? _ �(7I ,
Address j t "'X � Street Address/ State Road/ Lot #(s) C "t ' ( t
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River Basin
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❑HHF
❑IH ❑UBA ❑N/A
T
Adj. Wtr. Body >L t �'�
(6at./man /ulnkn)
❑ PWS:
Closest Maj. Wtr. Body
ORW: yes /C./
PNA
yes / no
Type of Project/ Activity
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Abu ing permit may be require y:
( Note Local Planning jurisdiction) i
Not s/ Special Con itions
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Agent or Applicant Printed Name
Signature "Please read lance statement on back of permit rw
Application Fee(s) Check #
/ IJ aoc uvac vi � on•.n � a.bui .n..b .•�.... .............�-.
I
PermitOfflcer s Printed. Name
Signatur !!
Issuing/Date Expiration Date

AGENT AtJTMOF3IZATION F0t2 CAMe pERMITAPPt t['Astnu
Name of Property Owner Requesting Permit:
Mailing Address: >/) J-- r
Phone Number.
Email Address:
I certify that I have authorized ZL ems r Fitt_ Qig
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
c iL ft
at my property located at I
in r�<<.�n�_County.
I furthermore certify that t 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.
Property Owner Information:
Slgnatur�ree
Print or Type Name
Title
2-v/
Date
This certification Is valid through

ADJACENT RIPARIAN P {QPERTY t?WNMST63 ENT
I hereby certi;y that I ovm property adjacent to 1V1Y.. a uri� J nq ,s
property located at ( ', iT AJ_'o " 1 1w r)
a — YA— i� Ssaaarese
on
in
(Waterbody)
N.C.
The appligant has described to me, as shown below, the development proposed at the above
J
i have no obJeC#ton to this propose;.
I havo ob)eotlons to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
Vndh4dualproposingdevotopinw»f uftfNfn#esciAf1on'b#hfiV'6ret?a hash �lr�tairegjl
5e,c d-+acke.d Map
waivER IMc-nRN
understand tt at a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be sat back a minimum distance of Is, from my area of riparian access unless waived by
me. (If you wish to waive the setback, You must InMai the . Y appropriate blank below .)
I do wish to waive the 15' setback requirement.
A
I do not wish to waive the 15' setback requirement, Our / 1t
Owner information)
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*Valid for one c8l0,Rd8r year attar signature* {Revised %eug. 20'f 4)

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TOTALED AREA WITHI
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LOT AREA-24420.0 SO fT
CHADWICK SHORES DR AE"
9 IMPERVIOUS COVERAGE-23.4R
60' R/W (PRIVATE)
asa aunwa SHOREB DMA
PAL SURVEY
R/W --"—'—"-------__R/W
'"FLOOD CERTIFlCATION••
SET a K 0 50' 100' 150'
FRONT- 275
TNIS IS TO CERnFY THAT THIS PROPERTY IS
SIDE-- '
LOCATED IN MOOD HAZARD ZONE 'AE' PER
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'1 CERiifY 1HAi iW9 MM WA$ DRANK UNDER MY
MIPERMSKYI FROY AN ACW& 4JR+EV MADE VNppi
FRDY A DEED RECORDED IN Om
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LOT S SLOQK: N/A SECMa ; N A
GAIRY CANADY SURVEYING
aNz.ow COUNTY STUMP swND TOWNSHIP
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P.O. BO%: S15
2780 KINSTON HIGHWAY
RICH E NC 28D74
AI Y 1.
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OFFICE: 83 4-44401E
(E: )324-8-8
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Project By
Subject Page
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