Lewis, Jake

[�CAMA / ❑ DREDGE & FILL No. 74955 A B C D
GENERAL PERMIT Previous permit#
CANew ❑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- /_ f -tom I Project Location: County I i
Address / ' _ E_.-i -'ii L ( Street Address/ State Road/ Lot #(s)
1
City I' "p� 11 States/'It ZIP-✓''
Phone # E-hail- Subdivision ✓A / _
Authorized Agent 4\ \ .. f' D I City ZIP
Affected Li OW SEW PTA ❑ES APTS Phone# ( ) River Basin
AEC(t): 00EA ❑HHF ❑IH El ❑N/A Adj. Wtr. Body !i (nat/man unkn
Closest Maj. Wtr. Body
ORW: yes,/ no PNA yes Q' no,,
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or Applicant Printed Name
Signature 'Please read compliance statement on back of permit"
Application Fee(s) Check #

NCDENR
North Carolina Department of Environment and Natural
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director
Date
Name of Property Owner Applying for Permit:
Mailing Address: 4
�f- woc d
-/ Cj
/'�' r-1
Resources
Dee Freeman, Secretary
!i `7 t+-/'/wit U /''
flIq -a-, x CU,
I certify that I have authorized (agent) Al C-y C-- J � to act on my
behalf, for the purpose of applying for and obtaining all CAMA
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Property Owner Signature
nits necessary to
W':O�-d c
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanagement.net
An Equal opportunity\Affirmative Action Employer— 50% Recycled \ 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �JC1 's
(Name of Property Owner)
property located at / / ✓ C Y 6
(Lot, Block, Rg�/ad, etc.)
on LI A LA Oad p k in _ !, W4 [//00, i 6 , N.C.
(Waterbody) GJ (Town and/or County)
Applicant's phone #: �J ' / Mailing Address: Zvi-) ut
,41M r3UY� /1/6 z 54 z
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
l�� / kGC1-/- 114
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Z 6 2 - !� /�
ephone Number
I
ignature Date
(Riparian Property Owner Information) -&
Signature
Print or Type Name
X / // //Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �- A2K, ZQZf -Ls IS
(Name of PropertyOwner)
property located at
(Lot, Block, Road, etc.)
on T/GLl/Lll�r%��j���, in ��►! �!/Bd�s N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:'���G Mailing Address: �C /✓
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be felled in by property owner proposing development)
/CoC%40�/�-o41,`-ze-�4z
�r a0
N
�k Sncj
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit) /
Mailing Address — Signature
Z— Kew
City/State/Zip Print or T e Name
asz-., -f���
Tele tune Nu er
ne ,
nature Date
3(q3
Telephone Number
1. Date