Trogdon, Russell

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AMA / ❑ DREDGE & FILL No. 73201 A B �. C D
Qi'ENERAL PERMIT Previous permit#
FNew []Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality / I %'"1
and the Coastal Resources Commission in an area of environmental concernQ�. pursuant to I SA NCAC / v
i / -© Rules attached.
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AEC(s): ❑OEA ❑HHF ❑IH
❑ PWS:
ORW: yes / no PNA yes / no
❑ ES ❑ PTS
❑UBA ❑N/A
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Subdivision
city --/ ZIP
Phone # O River Basin
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Agent or Applicant Printed Name
Signs ure� *'t Please read compliance statement on back of permit"
lA pli& ion Fee(s) - Check#
Issuing Date
f.
'rioted Name ^""�`•—---
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to Russell Carlton Trogdon ,s
(Name of Property Owner)
property located at 523 Odun) Dr
(Address, Lot, Block, Road, etc.)
on Queens Creek in Hubert N.C.
(Waterbody) (Cilyllrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
IQcation.
_ 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.)
4 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(property C
Russell Carlton Tro0don
Print or Type Narne
PO Box 1321
Mailing Address
Swansboro, NC 28584
Cily/Slale/Zip
510-326A808
Teleprone Number/email address
Uulr
'Valid for one calendar year after signature'
(Adjacent Property Owner Information)
�-
Si ma ar*
P nl or Type Nanie
Main Address
City/Stale/Zip
Tel hone Num er/email address
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Russell Carlton Trogdon S
(Name of Property Owner)
property located at
523 Odum Or
(Address, Lot, Block, Road, etc.)
on Queens Creek , in Hubert N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to n.
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 1 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner
Signature
Russell Carlton Trogdon
Print or Type Name
PO Box 1321
Mailing Address
Swansboro, NC 28584
City/Stale/Zip
910-326-4808
Telephone Number/email address
'Valid for one calendar year after signature'
(A jpcent Pr erty Ow infor ation)
t
jgna(ure� ���
Jq.11 E'S �xriy �r1 r(�pi i.�
Print or Type Name r
Moiling Address
Cd1/Slale9
rr/J PJ 7
Telephone Number / email address
(Revised Aug. 2014)