Crozier, James

MCAMA/ L DREDGE & FILL No. 73972 A B c; D
W
GENERAL PERMIT Previous permit#
lNew ❑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 15A NCAC % 1. I 't
0 Rules attached.
Applicant Name i n{ S :' %. I C l
Address I y f ( t /' ._
City Ii � ' Stated ZIP I %
Phone # (,I��) ! % E-Mail
Authorized Agent
Affected ❑CW ❑EW ETA El ES
❑OEA ❑HHF ❑IH ❑UBA
AEC(s):
❑ PWS:
ORW: yes / no PNA yes /r no
Project Location: County C i
Street Address/ State Road/ Lot #(s)
Subdivision
City ZIP _
/N�PTS Phone # O River Basin
❑ N/A /
Adj. Wtr. Body i nat fnan_/unkn
Closest Maj. Wtr. Body ' v
■■■■■■■■■■■■■■■■■■■■■
OEM ■ ■■■■■■■ ■■■ ■
...
..�.Poo
■■NS
:.
■M ■■ME
law
IS
■■■
■■■■■■■
■i■
■i■■III■■■■■
.®■■■.i■�..H..■■■■..■■®.■..■■■■■■..■■■
■■■■■■■■■
■■■■■■■■■■■■
■■■�■■■■■.1■■■■
■
-.. • , .. -
MEN
0
IS
----
■:■■■:
MEN
■■■■■
■■■■■
■■�■■
■■
■■�■I■I■:■■
■
■..■........■■1
0
IS
mienIN
■
MEN
IN
M
ME
ME
EON
■
■■■
■■
■■N■■■
■■I■
■■■■■■■I■10
■■
■�■■■:■■:■■N■■■�■■1■:■.■■
■■■■■I■IVAIG�■■:■
■■■■■■■■■■■■■■■■■■
■■1■■
ONE
■■■■■■Imoll
■
■■■■
No SEE ::::::I::
:':::::IRWI::gE
PAM
MEN NNE
I WIN
■H�■■:■'IN
�■:■m■:■■�■:::I:■■:::
■■::■1■IVAI■:
■■■IN■M■■■■■■■■ ■■■■■I■■■■9\■■■■I
■■■■■1■■O■■n
I■1.■■■■■■
g�■■�
IN I■i■:::::
■■■■■■■
V■::::E �■jMEN
�I■■R' .■■A■■1 loi
IL�11■ ..
■E I M
..■■::■:■:::�il�■C:a:eCC:=CCCC:C��@■C::::
■■■ I■ri■�■■■�■�l■
-
- --- --inion
■■o■■■®■■■0
�,i�ii::■■:■H■■ONE
■■■:■■■■
Agent or Applicant Printed Name
Signature z` Please read complaneatement on back of permit*'I
Application Feels) Check #
PermitOffcer's Printed Named /
Signature
Issuing Date Expiration Date

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to p -_ C.fn7_t er is
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on 1 tent g VU 00tY Q _, �CA�� Jr / N.C.
(Waterbody) (Town and/or County)
Applicant's phone 9:qk)aI4 l Mailing Address: 101 LLidwi
NPR W Ns�
He has described to me, as shown below, the development he is proposing at that location, and, 1
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
l& I do wish to waive that setback requirement.
-------------•------------------- -------------- --
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development) Sg ti I�aGhl`I
4 fi n
(Information for Property Owner Applying
for Permit)
Marling Address
City/State/-Lip
Telephone�Number
Si re Date
Property Owner Information)
��/�� Signature
—
rint or Type Narne
Telephone Number
Date

NAND DELIVER
ADJACENTRIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTIBOATHOUSE)
5 mes C(o z�� I hereby certify that I own property adjacent to , _ s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
onTefA C1�� C`CV1LiX- - —'in tA-Y—L Cia1PI1 CnUrt�,N.C.
(Waterbody) (Town and/or County)
Applicant's phone N:QJOQ(91 QD1Mailing Address: )n 1 S"Ia of
�b A) rn NL
l le has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
t I do wish to waive that setback requirement.
--------- ----------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befr[ied in by individual proposing development) S2t �iitiGht��
I�---r--i—o -,
---------------------------- ________________ _
(Information for Property Owner Applying
for Permit)
gL .s�t�„I Cl
Mg Address
City/State/-Lip
Property Owner Information)
Signature
Print or Type Name
0
Telephone Number
Date

�
S
(�
q
J
c�
C
r
t
(
�
J
l
co
S7
C.•
v
0
q-,
0
f o
li'
v
to