Inge, Gail

FCAMA /P DREDGE & FILL No. 74959 A B C D
GENERAL PERMIT Previous permit#
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 Resources Commission in an area of environmental concern pursuant to 15A NCAC
•.� Rules attached.
Applicant Name i i t �� I i Project Location: County
Address 1- J Street Address/ State Road/ Lot #(s) n 41'
City n i i State zip
Phone # -�" i/
O - f E-Mail
�,
ry
Authorized Agent
i i i i I (I»
❑OW
..d PTA
DES
©PTS
Affected
,❑EW
❑OEA
❑HHF ❑IH
❑UBA
El N/A
AEC(s):
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier
Fixe
Float
Fing
Groff
Bulk
Bash
Boat
Boat
Beac
Oth
She
SAV.
Mor
Phot
Waiv
Subdivision ", ' % '
City % i�-.l ZIP
Phone # ( ) River Basin A
Adj. Wtr. Body//" ( , k'- r(nat /man /unkn)
Closest Maj. Wtr. Body
I
a
(Scale:
Mrs
■M
III
M■■■■
III
■III
■III
N■
■■■■ONES■■■■■■■■■■
ONEE
MEN111:::::::::
:M■■■�C■■■■N■M■ME
::::■:30::�:0
MEN
■■■■N■■■■■■■N■■..■
MEN
N■NENNN■EN■
NOON■■
N■■■N
III
■ANIII
ONMEN
:
ME
III
MEN
l:::::::monoMEN
■■■■■■■■■■■
..OEM
..III
so
..■■■
NNE■■■■■■■■■■■SS■■■■M�i■NE■■■■
III
■■■E■
III
!�S■■
SS■■■■■■■■EN■ENE■■EN■■■N■■■■E■■■■N■■
EME
E-SEEN
NES-NEE
SEEM
MEN
ME
mom
I
mom
MEN
0
ME
ME
ME
■■EN■■■■■N■■■■■MNOM■
M■■ME■NEMS:SMSS■■
No
M
III
M:Ni:ms
MEMO
E��EEEMEME■MEM■:NE
C
::
:5■S�
.�...i:ii
:NN■®
OE■
.
No
III
mi!■■■
jialfiMEN
N
N■■
■EESE
N■MN
:.■■■.■i!■■■
■ME■■■�!■■■
■MENENN
■NOON
:■E■■M■
WOMEN
■ONE
■■■E�HIM■.:■M■■■.0
E
::
:line
::�.
::-
■■■■
■■EON■■■■■■��■IRE
RENll■�:
Length
■■■E■■■■■N■■■B■
N■■■MOEM■■MN■■■N■M■M■
notsure yes
MEN
imimmmo
MEN
,torium: n/a yes noM■■■■E■N■■■■■E■■■■■■!!■■■■MN■■■
■EMMMN■
A building permit may be required by: I cc °`-, \ "'r "4
( Note Local Planning Jurisdiction),
Notes/ Special Conditions ��' < 1'
i
Agent or Applicant Pt anted Name
Signature " Please read compliance statementon backofpermit"
///
Application Fee(s) Check #
IJ See note on back regarding River Basin rules.
i
I
PermitOffcer's Printed Name
Signat re
Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: G RZL 1—� G' C
Mailing address: j 00A —
IZuC_GQ.S 0o
C4G-,-oAa ) N_C. :)') 1 S 3
Telephone Number: -33 b- DaG - U:2�qS
I certify that I have authorized Q2 r I � I l AD (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of V ZN VL '\'c VisJG WILL L
at my property located at �Mip �f_A' 'S %6- , QX,UN(E —k 0 C - ��S`iC'
This certification is valid through
(Property Owner Information)
9`1. _ 4 . OM 42r
Signature
Print or Type Name
�)I, nb?
Title, co. owner or trustee for property
11-)01
Date
JIL - (4 3-2
Telephone Number
Email Address
(date).

IN I
L I hereby certify that I own property adjacent to Ga-ix, -i� 's
G (Name of Property Owner)
property located at y 000 SC —A C— G1 i 2ZV
(Address, Lot, Block, Road, etc.)
on j��t.� in (yr' W,P8(? Py (1. N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc
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
A [-XSiSTNCr /' -
� T T
_WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 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.
(Prorty Owner Information —
ml
. na ire
_�T_L.L, 0 4tAra
Print or Type Name
10 O'S v i1G aT Dim v
Mailing Address
City/State2ip
(Adjacent Property Owner Information)
(S' nature
�aLc
Print or Type Name
Mailing Address
Air
City/State2ip
elephone Number
Telephone Number u

I hereby certify that I own property adjacent to C` �(_ 03 CA % I
(Name of Property Owner)
property located at 1 f d S[AQA�l C
(Address, Lot, Block, Road, etc, _
on L lJ in i3CwQ262v ,N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loq�#ion
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)
Lk �xS;-5— r
y
WAIVER SECTION I
I understand that a pier, dock, mooring pilings, 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)
S' rzT_
C=1T& 014 LJ�iLLt-`S
Print or Type Name
3oLf ScLi P/
ding Address
Od"E t7
City/State/Z�
235,1�
Telephone Number
2s � - C,3 _-� --3`) -IS
(Adjacent Property Owner Information)
:_ . 4r.�
Si afore l �—
r�1� 1 N C
Print or Type Name
IS 2N 2"iscx-in
ailing Address
aR��.�ra� NC_,
Cit tate2ip
Telephone Number