Flowers Jr. Kent

®^ L9 CAMA / 71 DREDGE & FILL No. 73284 A B C D
GENERAL PERMIT Previous permit#
)z7New ❑Modification L1Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commi'rsion in an area of environmental concern pursuant to 15A NCAC
Rules attached.
Applicant Name
Address
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City
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Phone # ( '' ).
E-Mail
Authorized Agent
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❑ EW ❑ PTA AES PTs
Affected
❑OEA
AEC(s):
❑HHF ❑IH ❑UBA ❑N/A
❑ PWS
ORW: yes / no
PNA yes / no'
Project Location: County_
Street Address/ State Road/ Lot #(s) i
City
ZIP
Phone # O River Basin
Adj. Wtr. Body / ' \ (nat /man /unkn)
Closest Maj. Wtr. Body ' (
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Agent or Applicant Printed Name
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Signature *'t Please read -compliance Statement on back of permit
Applicilion Fee(s) Check #
PermitOfflcer's Printed Name, J
Signature
Issuing Date Expira ion Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Kew ( . 'F 10 wcr5 Ti. 's
., (Name of Property ner)
property located at �� O � � i�c rc- � �Q
(Address, Lot, Block, Road, etc.)
on �/e �icc �1.e in Cf. <. rrn*, E . , N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
local,oy
1/ 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)
S AL , -P.i\ �'I-e- -k-0
✓vz�SG,�of 's bilk<<_� e� E«� c�/,���wy zs-'
L'�- A-` \\
b o "i'L da'-y -r-
6, C , se"
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
m,. (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)
1
Signature
cvck (7 ,'Ftry t✓i i.
Print or Type Name
300 s, Q
Mailing Address
City/Stat-0
Szi (�
eletpt pne Nuri er/email address
2- I
*Valid for one calendar year after signature*
Owner Information)
I
'Number/email
2')tlgig
Date
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (—ek!�—' ( . 'F 10 we✓5 Ti. 's
(Name of Property ner)
property located at � b D S c � �c . t-r- IL
�t (Address, Lot, Block, Road, etc.)
on kle.ecc r�i�.e� in Cf, <rr , h ,N.C.
(Waterbody) (City/T)wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
t*TloorI have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development mustfillin description below or attach a\ site drawing)
P v N l tT C k i,<<am_5�Z Qe fit"cc �ov_.��"l ✓z�4, 1v ids � 40
/Ve
cL
13L�:1b2 C' C"—GvC
l��_Ck
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 requiry WVt. /j
(Property Owner Information)
Signature
_. hC vck (.'F :1:i.
Print or Type Name
300 Scrrf
Mailing Address
dli � f, L
City/Stated'
Telephone Number/email address
I I �--V1<8
Date
*Valid for one calendar year after signature"
Print or TypenlA
Name
a0Z (.('e0,nj
Mailing Address
/�✓ G i I�� ✓ram _ Nt�- 7 <S.S(,O
City/State/Zip
zsZ- 6-10—
Telephone Number/email address
/— ZU —/V
Date*
(Revised Aug. 2014)