Gadow, Ryan

i I CAMA
/ ElDREDGE & FILL No. 75925 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 Resources Commission in an area of environmental concern pursuant to 15A NCAC
O Rules attached.
Applicant Name Project Location: County _:
Address Street Address/ State Road/ Lot #(s)
City. —State ZIP
Phone # (' ) / ` f E-Mail Subdivision
Authorized Agent City \ c ZIP
Affected
❑ cW
AEC(s):
EJOEA
❑ PWS
ORW:
yes / no
,CREW D PTA J" ES ❑ PTS
❑HHF ❑IH ❑UBA ❑N/A
PNA yes / no
Phone # ( ) River Basin 'I/ /f
Adj. Wtr. Body (nat)/man /unkn)
Closest Maj. Wtr. Body /I;!
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Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit**
Application Fee(s) Check #
i
Permit Officer's Printed Name
Signatur
L
Issuing Date Expiration Date

dodoop signature vcr Lcaaon �T,w_m. r•.��.`��^._,.
W of l�rrty' t"h�vr'r�sa fZesq�tMq� W�aftre Lath' 9 CtnLcri � //in ,.�
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to ad on "VY bettaff, for thO W APOSO W bppt/IN till aard obtaavng all ChMA peefmtts
auy 101 the lottowgng proposed dovelopment. DV ✓PiiaJ
ram"- heivi-i"d
at MY ptopeaty bcafed at Lot 7 N7fy'-e, (4.1QG(
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1 feftUx"Mary CefhfY UU4 1 11M IMM00M0d to 9fdnl, BfKf d5 w7 fact grant pQrrrw"x%" ki
tDOW* u'i of Coutstal Mfnzatgankrnf aI&A the Local Por wt Oft or 014 f1w arr�vfrf t to Oneof
on trig afore nwfff"wd lorkh at Conraacttean aath evatea.-)&V information toMfod R.) fhls
pem* apprti ab&I
Nowy owner Intofmitlon:
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=SUPPLY=
25 BLANTON RID SE
SUPPLY, NC 28462-3590
367616-0462
(B00)275-8777
10/29/2019 03:25 PM
------------------------------------------
Product Oty Unit Price
Price -------------
- st-Class Mail@ 1 $0.70 $0.70
ter
(Domestic)
(PITTSBORO, NC 27312)
(Welght:0 Lb 1.30 Oz)
(Estimated Delivery Date)
(Thursday 10/31/2019)
tified
$
(LISPS Certified Mail H) .
(70181130000133584724) `
st-Class Mail@ 1 $0.70
$1
..:ter
(Domestic)
(NORFOLK, VA 23508)
(Weight:0 Lb 1.30 Oz)
(Estimated Delivery Date)
(Friday 11/01/2019)
,tified
$3 `
(LISPS Certified Flail N)
(70181130000133584724)'° 0
urn Receipt
$2
SPS Return Receipt B)
(9590940250399092744705)'
st-Class Mail@ 1 $0.70
$0
.ter
(Domestic)
(PITTSBORO, NC 27312)
(Weight:0 Lb 1.30 Oz)
(Estimated Delivery Date)
(Thursday 10/31/2019)
rtified
$3.
(LISPS Certified Mail N)
(70181130000133584724)
.urn Receipt
$2.1
(LISPS Return Receipt P)
(9590940250399092744699)
.,ifixbd Posta(ie
($4.2C
(Affixed Amount:$4.20)
---------------------------------------------
Total:
------------------------------------------
$14.0
------------------------------------------
Credit Card Remitd $14.00
(Card Name:MasterCard)
(Account O:XXXXXXXXXXXX3472)
(Approval N:0546OZ)
(Transaction 11:579)
(AID:A0000000041010 Chip)
(AL MASTERCARD)
(PIN:Not Required)
---- -------------------------------------
Text yob-fracking number to 28777
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ADJkCENT RIPARIAN PROPERTYOWMI R STATEMfAT
I hereby cendy that !own property ad)acent to ��i + .� f' 1 )(( � �(/_'
.i_._�.—..�,,f •..vx:�i � ♦C,rY
tt t¢'
Property located at me of Prop -- h 6 � S` ,S� o �j5 s_� �•^
on
(Address, cat, t
Block, R a etc,)
,,. .-• ...
..___..�<_.M Lane,_..--__...-_._. in NT
(Wa rbody
(CftyRaxn anrid/l
or County}
The apiliicant has described to me, as shorni below. the developmen: pirprrsed at the aWve %,cair..�
i have no objection to this proposal,
I have objections to this prolmal.
R DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development nwsf rill in description below or affacb a site drawing)
(^�
V-OD0'3C
1
,WAIVER SECTION
understand that a pier, dock. nworing PJ-:ngs. breakwater, boathouse..:tt, or grout mist bri set ba::k 2
minimum distance of 15' from my area of riparian access unless waived by me (If you wish to waive
1V setback, you must initial the approprale blank below.)
rule
I do wish to waive the 15' setback regmrement.
t do not wish to waive the 15'se!back requirement.
rty Owner)nformation) (Adjacent PropanyQwrier Information)
Type Na{' Pdnt a lvanje f(�.."�Q,�-
.d ress Mail ag Address
tNfM- �"� -Cam.{��� IVY 2��JJ
`:[') �j
cuyrsrata2ip C
to h/4rnbeq refephone fwnmoer
Date
(Renssd 6r'siv?U 12J

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION)WAIVER FORM
Name of Property Owner:
C,
Q,
Address of Property:
v,sk, N
o\\e
(Lot or Street #, Street of Road, City & County}
Agent's Name #: N0-3QfntN..) (7"a',.) Mailing Address: �\,wh2f—,�`1�
Agent's phone #: —` U,-IAND
bra
I hereby certify that I own property adjacent to the above refarenced 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.
XI 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 f0CM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 28405.3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
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 must initial the appropriate blank below.)
t do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sig e
Print or Type Name
Mailing Address ii J
City/Stafe2ip
Telephone Number
\01M kq
Date
(Adjac t Property Owner 1 formation)
Sigt attire �J l
Print or Type Name
a
AV 4 0V 3212
Telephone Number
Dnte
Revised 611812012

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._-----------------------
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-----------------
SUPPLY
25 BLANTON RD SE
SUPPLY, NC 28462-3590
367616-0462
[phone]
11/16/2019 10:20 AM
- - -- --- -- ----- ---------------------
i i aduct DIV Unit Pr h r
Price
-----------------------------------
fu st-Class Mail@ 1 $0.70 $0.7U
Letter
(Domestic)
(PITTSBORO, NC 27312)
(Height:0 Lb 1.20 Oz)
(Estimated Delivery Date)
(Monday 11/18/2019)
Certified $g 'if)
(USPS Certified Mail 0)
(70190140000020605869)
- ------------------------------------
101,11: $,1.2u
- ------------------------------------
i :,,,11 $4 li i
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