Jackson, Don & Brenda

LJCAMA / ❑ DREDGE & FILL No. 75006 A B C D
L�JGENERAL PERMIT Previous permit#
New ❑Modification [-]Complete Reissue ❑Partial Reissue Date prgviou,
` pe mlt issued
A,`autho ized by the State of North Carolina, Department of Environmental Qually /
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rule{ attached.
Applicant Name i r i-�� '� I<� ( Project Location: County x�
Address .'i Street Address/ St to Road/ Lot #(s)
City \_(\ i State _ZIP
Phone #L( T/) %E-J I�il —_ Subdivision
Authorized Agent ' l ( �J �, i City ZIP Y .�
A.�
Affected �*cw Ew tF TA ❑ Es ❑ PTs Phone # ( )RiverBasin I _�
AEC(s): D OEA ElHHF LJ IH ❑ UBA El N/A Adj. Wtr. Body i(hat /man /unkn)
El PWs: J
ORW: yes / no PNA yes /'no Closest Maj. Wtr. Body
Type of Project/ Activity
Fixed Platform(s) A
Floating Platform(s)
Groin length
number
Bulkhead/ ftiprap length_
avg distance offshore_
max distance offshore
Basin, channel
cubic
Boat ramp _
Boathouse/
Beach Bulldozing
Other' f�
i
Shoreline Length _
SAV: not sure yes no
Moratorium: n/a yes no .
t ,:
Photos: yes
Waiver Attached: yes
A building permit maybe required by:; Fes(:,)'.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Sire'"*'Pletaseread compliance statement onback o(permit""
+ (—� .T 1-�J t4c7 CUf C(l
Application Fee(s) Check #
(Scale:
❑ See noteonback regarding River Basin rules.
y..l
Signature
I7
IssuflngDat E pirati nDa

a
MUM
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date
Applicant Name .T., 4-
Mailing Address
N� C-f-
John E. Skvarla, III
Secretary
N�Wodrf
I certify that I have authorized (agent) Cr : c- to act on my behalf, for the
Purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
a//,, &
oJUL- LR'VIXr ps
This certification is valid
Signature
(date)
at (location)
C t N�rj,ra I- f- NC
�j -m
RECEIVED
JUN 11 '10
DCM-MHD CITY
400 Commerce Ave., Morehead City, NC 28557 11
ww.
Phone: [phone] FAX:[phone] Internet: wnccoastalmanagementnet NOhCarohna
An Equal Opportunity t Affirmative Action Employer Nahlid 1,k

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 426 ,.) + Il `e-l"04 Zfe- Cso 's
(Narr�r7�e of Property Owner)
property located at a� - Z-h d �' 7
7(Address, Lot, Bock, Road, etc.)
on ci in NEB 4c r fi N.C.
(Waterbody) (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
l�cl6
% SX7b
r-
s:r/as
RECEIVED
JUN 17 2019
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, litar.grpjp,® CITY
must be set back a minimum distance of 15' from my area of riparian access unless w d
me. (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
X I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sig/wtu/rey 7 �j
�'" V
Prt or Type Name /
of aCu! Llle/c+�i •✓c �`t"
Maiiif �g Address o
I IP y4o h + N 70
City/ ate/Zip
Telephone Number/email address
Date
(Adjacent Property Owner Information)
�.� P�
S�ggnature
L5m "— Qc�,r Vim✓
Print or Type Name
10 I 11 v J Q44
Mailing Address
r-1 PI"I Cad-E
City/State2ip 17ooW+(>o� IW '�"'1 e o�.r+o� I c5•^
Telephone Number/email address
(0-(e-V)
Date*
*Valid for one calendar year after signature*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to o u , p! E' "XJ,4 Ac 4scytl 's
(N me of Property Owner)
property located at cc) 1 ��� v E �ft;✓Ti •75 C f
(Address, Lot, Block, Road, etc.).
on 4 c So � A'-( , in /yCWpor . f N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc�at' n.
� I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing develgpment must fill in description below or attach a site drawing)
pS-fr& LY o ✓
70
RECEIVED
JUN 17 2019
DCM-MHD CITY
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 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
eo4) Q` Nr�Acz('sov
Print or Tye Name
RO/ ,77�
Maili % g Address
295 76
City/State/Zip
Telephone Number
(n -%- r-o
Date
(Adjacent Property Owner Information)
Sz Sture
Print or I ype Name
Mailing Address
(IC_ 2--2S �u
City/State/Zip,-, Z\�
Telephone Number
lam, `t-2 v LEI
Date
(Revised 611812012)