Flowers Jr. Kent

®❑ CAMA / ❑ DREDGE & FILL No. 75094 A , D
GENERAL PERMIT Previous permit#
El New ❑Modification OComplete Reissue []Partial Reissue Date previous permit issued /, 7 J
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 w' Project Location: County - L P' i
I L
Address Street Address/ State Road/ Lot #(s)
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City �� State L ZIP f, %l'
Phone # (_) E-Mail Subdivision
Authorized Agent
Affected ❑ cw
AEC(s): ❑OEA
❑ PWS
ORW: yes / no
❑ EW ❑ PTA f kS ❑ PTS
❑HHF ❑IH ❑UBA ❑N/A
PNA yes / i co/'
City / ZIP
Phone # O 1 Ri er Basin
Adj. Wtr. Body f (' k (dai)man /unkn)
Closest Maj. Wtr. Body. ("q-^
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Agent or Applicant Printed Name t'.. ` PermitOfficers PrintedNarn;-
Sign@Lture '* Please read compliance statement on back of permit'r'r. Signature
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Application Fee(s) Check# Issuing Date Expiration Date

®�JCAMA / ❑ DREDGE & FILL No. 73284 A B C D
GENERAL PERMIT Previous permit#
IINeW ❑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 Commiisi5n in an area of environmental concern pursuant to 15A NCAC-
O Rules attached.
Applicant Name _ Project Location: County
Address Street Address/ State Road/ Lot #(s) i
City
Phone #
Authorized Agent -
Affected Ll CW
AEC(s)i oOEA
❑ PWS:
ORW: yes / no
State/' ZIP
E-Mail
DEW ❑PTA Aes —h PTS
❑HHF ❑IH ❑UBA ❑N/A
PNA yes / no
City
Phone # O
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
River Basin
(nat /man /unkn
.-
'.'.CC'
�. r� T
Agent or Applicant Printed Name
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Signature **Please read -compliance statement o
ba
Application Fee(s) Check #
PermiTOfficer s Printed Name/
Signature /
Issuing Date -Expira ion Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to k!N: ( , 'F 10 we✓5 Ti. 's
(Name of Property ner)
property located at '3 6 p � � ;rf-c,,,c- �,Q
(Address, Lot, Block, Road, etc.)
on /e�icc ;�,er ,in , � rr ,�t, ,N.C.
(Waterbody) (City/T)wn and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatioy
� 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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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.)
t I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
c (
Print or Type Name
3o© Sc ��6✓N i2LQ
Mailing Address,
City/State tp
(, I'l —
7e/ep1 pne Nu/nv Il er/email address
12-
Date
*Valid for one calendar year after signature*
Owner Information)
©�N6
Telephone Number/email address' /
Date
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to fc w ( F 10 wets Si. 's
(Name of Property ner)
property located at
(Address, Lot, Block, Road, etc.)
on !1/�cG�c ��.ef ,in Cr. t.0 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
locatioy
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
\or attach asite drawing)
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G��S�-
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.)
1 I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requi
(Property Owner Information)
Signature
Print or Type Name
Apo Sc - rQ
Mailing Address
City/Statgl '
(a s z) � I'1 — C? 0 �7
'Telephone Number/email address
1 1 ��O U S
Date
Print or Type Name
2- 0
Mailing Address
A / e,.✓ die v�-- _ AIC.- 7 `b� 0
City/State/Zip
Z SZ- 610- 11/40
Telephone Number/email address
/" Z!, -/Q
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*