Carter, Matthew

®CAMA / ❑ DREDGE & FILL No. 75012 A B C D
E NERAL PERMIT Previous permit# #New Modification Complete Reissue Partial Reissue a. , ,�,d: Date previous permit issued
As authq ize❑[]Complete❑
d 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
Rules attached.
Applicant Name
Address
City i State_i ZIP
Phone # 7� ) Li. - h; ( E-Mail
Authorized Agent — "
❑ CW Q W C]`R^TI A ❑ ES ElPTS
Affected
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(sIL���.x""� i
Floating Platform(s) !• f
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
(_ _..
BoathousA/.Boatlif%
Beach Bulldozing -�`—
Other
Shoreline Length _ _
SAM notsure yes no - -
Moratorium: n/a yes no
Photos: yes no _
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning �•�'�a'^«'^^�
Notes/ Special Cont
1
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City— ZIP__._
Phone # (_ )_ River Basin
Adj. Wtr. Body (nat /man /unkn)
Closest Maj. Wtr. Body
(Scaler
y� Xi � - ❑ See note on back regarding River Basin rules.
f
Agent or Applicant Printed Name
Signature ** Please read compliance statement on backofpermit**
Application Fee(s)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (h o,� ew G Gres 's
(Name of Property Owner)
property located at 5Za1 Webb c}
(Address, Lot, Block, Road, etc.)
on S{Voo„ers C reek in r';L N.C.
(Waterbody) (City/Town andlor 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 bave ohjecii_ons_to_this_pr_oposal-
__-
utbUKIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
�0N I. � To
DCM MHo Or(
_:-__ WAIVER SECTION
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 11 t 'nitial the appropriate blank below.)
-y— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
irroperty owner Information)
116- C
/�na Si ture
ai9. er-j Cal4ee--
Print or Type Name
9,70 &&ebb Ci1-
Matlmg Addres
11arPL,� 62� /Q, 8
City/State/Zip
(3 36 ) S-Ycl - I qy
Telephone Number
3o�r/fiV rd y
Date �
(Adjacent Property Owner Information)
SignatWe
-1� 4* Ion /1'/or
Print or Type Name
`I7/ f 4re761e-// O3 fl*0 308
Mailing Address
City/State/Zip
�5 d--3—
Telephone Number
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ Mo,-N-�b,ew Ccr�er I
property located at y z v l w ebb c.}. (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on 5?aoy ers Creek , in _ /flareye�rof C';-y
(Waterbody) (City/Town and/ r 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.
---A halo objections to this. -proposal.
utSCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
RECEIVED
J U N 11 ':19
DCM-MHD CITY
-- - WAIVER SECTION
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, youst 'ni itial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(vroperty Uwner Information)
Signature
Print or Type Name
SZolc�-
Matlmg Address
/y/aieG,euo( Cr><y AC ZdY77
City/State/Zip
f33C) sS �i -/9Ke
Telephone Number
/0 3'uiv ?of 9
nuhrrm
(Adjacent Property Owner Information)
=Si nature
&4-. rJ_ /�TCI<G�f/ �y _
Print or Type Name
Mailing Address Z
_ °teas Cif 1/6 2 O C 9 S(
City/State/ ZiIf/3r
Telephone Number
Date
(Revised 611812012)

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