Baker, Ed

(-JCAMA / Li DREDGE & FILL No. 74936 A B C D
GENERAL PERMIT Previous permit#
QNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal '=sources Commission in an area of environmental concern pursuant to I SA NCAC i ✓// /
❑ Rules attached.
Applicant Name /, + '; Project Location: County ( r / _
Address C, (` C' �' => /� Street Address/ State Road/ Lot #(s)
>( State/ ( Zip
(�U
Phone # (�(y 'E-Mail
Authorized Agent
Affected D CW ❑ EW ❑ PTA
): DOEA ❑HHF ❑IH
AEC(
❑ PWS:
ORW: yes / no PNA yes / nc
Type of Project/ Activity
Pier
Fixe
Float
Fing
Groff
Bulk
Basin
Boat
Boat
Beac
Oth
Sher
SAV
Mor
Phoi
Wai,
DES ❑PTS
❑ UBA ❑ N/A
Subdivision
City % �< , 1 f=', _ ZIP
Phone#O River Basin
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A building permit may be required by: e ' ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) �� ' /
Notes/ Special Conditions j \� ' ✓ ✓ l ---`e4
�ppl t Prin d Name PermitOfficer's Printed Name
Pleas compliance statementon backof permit** Signatures
( () Nl<<�
i Fee(s) Check# Issuing Date Expiation ljate

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION[WAIVER FORM
Name of Property Owner: _6�' _9,.V-t/-
Address of Property: _I S 5 `f 1 y ja.4 oa. —L
(Lot or Street #, Street or Rd, City & County)
Applicant phone #: *0 4fl /G ZQ Mailing Address: Zoo&
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions, must be provided with this letter.
/I_ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.neticontact—dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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 i w er Information)
Sig a ure
rid LE. ,
Print or Type Name
%ran^ Vaate
Mailing Address
Ite4a�d JJc, Zg.-76
City/State/Zip
q/ o io 9/ %6 Zn
Telephone Number
Z oCc /aK
Date
(Riparian Property Owner Information)
f`
Signature J
Print or Type Name
00 I V.tsiy 5f
Mailing Address r
/\"� t!'f �� r L1 G t'! 1" iVC ,,, vi' ) f
City/statelzip
Telephone Number
Date
_(I-1q

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 6t g oyo '
Address of Property: IN 5 `( 1 c(a, d Ko �.L . FF' Ions:; L
(Lot or Street #, Street or Roa ,City & County)
Applicant phone* *0 4p/ /4 ZD Mailing Address: Z000 t/ I a./
2 v A P) G
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
Ye I have no objections to this proposal. I have objections to this proposal.
if you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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 7er Information)
Sig a are
tad & L c
Print or Type Name
-2o na Vas., Q,,, /
Mailing Address
1&e�Pprd tk- 713?<
Cify/State/Zip
0i/ 0 6 9/ 16 Zn
Telephone Number
Dale
(R' avian \Pr
olpnerrty Owner Information)
Signature
IkA F. rn(AS a r2
Print or Type Name
/$II WIr4bsaR -S
Mailing Address
WLLSalJ NC, 2-1$93
City/State2ip
1S`a-a4�-5�935
Telephone Number
Gcgi' � 3,3 Ito I £�
Dale

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