Morris, Marvin

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MCAMA / R DREDGE & FILL N2 71678 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 .. A/
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC !.� l /
❑Rules attached.
Applicant Name 1 1 ! �� A (" >
Address
City State ZIP
Phone #
( )_ E-Mail
Authorized Agent
Affected OcW C1EW FIPTA -DES �PTs
A
Affecte D OEA ElHHF ElIH ElUBA El N/A
❑ PWS:
ORW: yes / no PNA yes / no
Project Location: County
Street Address/ State Road/ Lot #(s) % / )/)(
VC'.
Subdivision
City ZIP
Phone # ( ) River Basin
Adj. Wtr. Bed
Closest Maj. Wtr. Body
(nat /man /unkn)
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Agent or Applicant Printed Name
Signature ''*Please read compliance statement on back of permit*'r
Application Fee(s) Check #

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date �,o
Name of Property Owner Applying for Permit:
A Q t/ln AjC) 'i".S EXecwl-o,�
Mailing Address:
Sclnora. At c
I certify that I have authorized (agent) i e(LI /?P5 w to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) /3JA kew ` ,
at (my property located at)
This certification is valid thrill (date)
Property Owner Signature
Y121l1"5
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastaimanagement.net
An Equal Opportunity \ Affirmative Action Employer- 50% Recycled \ 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to /rlr)VUi i') Al orri S C*cr A"y— I
_ I (Name of Property Owner)
property located at
on
(Waterbody)
(Address,
, in
and/or County)
N.C.
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
(individual proposing development must fill in description below or attach a site drawing)
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Information)
M ding Address
�ei1loPc�, N.4 273 4/3
City/ tat /Z�
Telephone IN imbber/email address
Date
(Adjacenterty Owner Information)
6
1 �
Sig ria(ur�* JM
Pint or T pe Name
Mailing Address
City/State2ip
�15-o - A Of�o
Teleph ne Num er/email address
��z�
Da

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to A4A)6'1 / 00'S I /�'-Y e'-L Ly— s
(Name of Property Owner)
property located at 102 I�IneU i uu 4v
(Address, Lot, Block[ -,Road, etc.
on , in �f fcb�GY� l 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
(Individual proposing development must fill in description below or attach a site drawing)
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro er�ty Owner Information)
Srjaf�re
API/ivl Y f 6 iS
Print or Tye N me
Ma ling Addres
clfc� �4 2 7 3 �f 3
City/stat !Ze p
Tele hone Number/email address
st/�1/lK
ate
Print or
Name
Matrn Addres >
1� � A)L () it M �)
City/S,(ate/z' y
Telelone Number/email address
Da e*
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