Fleming, Elizabeth

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ICAMA / VDREDGE & FILL NO 71627
-. A B C D
GENERAL PERMIT Previous permit#
XNew ❑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 I SA NCAC
j !! I MRules attached
Applicant Name Project Location: County 4 {
Address Street Address/ State Road/ Lot #(s) c1
r/ NU1'ZIP City i i r'? f' I I r : 'A 44tate `1 ) r' .
Phone # ( ) E-Mail
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Affected ❑CW W _[)1 PTA _ CI ES . VVPTS
AEC(s): 00EA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier
Fixe
Float
Fin&
Groff
Bulk
Basi
Boat
Boat
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A building permit may be required by: ,i '1 l t ) e 1l /I' i7
( Note Local Planning jurisdiction) j
Notes/ Special Conditions \ Q r -
WC
A.genk or Applicant Printed Nam
Kini nature " ''" Please —read compliance statement on backofpermit**
grn.W I'x
Application Fee(s) Check#
❑ See note on back regarding River Basin rules.
�36•;a C on/7�
PermitOPocer's Printed%a!m"Je
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Sin Lure
Issuing Date xpiratio Date

02-09-'15 13:55 FROM -
I-017 P0001/0003 F-056
North Carolina
Pat McCrory
Governor
Date
k MWA
��E
Department of Environment and
Division of Coastal Management
Braxton C. Davis
Director
Applicant Name E W -Z j (E► PC
Mailing Address /5111
�i
Natural Resources
John E. Skvarla, III
Secretary
I certify that I have authorized (agent)qj!6% to act on my behalf, for the
purpose of applying for and obtaining all LAMA Permits necessary to install or construct (activity)
'15A 0 fk L4,
This certification is valid thru (date)
Signature
at (location)
400 Commerce Ave., Morehead City, NC 28557 nC
Phone! 252-808-28081 FAX: [phone] Internet: www.nccoastalmanagament.net '�`%i'.fryYlf/�ya�rro' l%i is
An Equal eppotluniV l Ammiabve Action Employer (/ YW4rLL1l lift

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to !' j,►-* 004) Lim 1 NE' 's
(Name of Property Owner)
property located at
Lt)
on G1'fl.1i�L ,in Y�'SI�i✓C1 N.C.
-CE(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 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)
Gpo�
e AL
PuE%-ASIe 5'I4ti1
prNQ tYlK11L-
WAIVER SECTION
P✓(�'
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
I�u2AP;C-f4.1 ( N1)v6
Print or pe Name
Mailing Address
tTk HDI'L S +[) R 5
City/stwegip
Telephone Number
Date
C lk
(Adj4cent-P operty Owner Information)
Print or,Type Name
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Mailin Address
vt� try
r`lt,r/Ciofc nin
�42*hon Number
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Date
(Revised 611812012)

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