Fugate, William

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G4MA/ El DREDGE &FILL y�.yb,
No. 74933 A
8C,.j D
GENERAL PERMIT
Previous permit#
14144ew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resour es Com fission in an area of environmental concern pursuant
to I SA NCAC
❑ Rules attached.
Applicant Name / . fll t G ` ' i 4 r f
Project Location: County
Address V %, t ' J
Street Address/ State Road/ Lot #(s)
(
City l 'e f / �' State k,/( ZIP
Phone # ail L
Subdivision
f (/._..,
City ZIP
Authorized Agent 1/ i # -
—/ _ _
Affected ❑CW JG EW LlPYA ❑ES ❑PTS
Phone# ( ) _ River Basin
AEC(s): ElOEA ❑HHF LIIH ❑UBA El N/A
Adj. Wtr. Body _ _ _
(nat/man /unkn)
❑ PWS
ORW: ye\/ no PNA yes / no
�,-"'
Type of Project/ Activity
Pier (dock) length_
Fixed Platform(s)
Floating Platform(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
Boat ramp
Boathouse/ Boatlift
Beach Bulldozi(ng f
Other c) X
Shoreline Length
J
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no _
Waiver Attached; yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
M
00,
Closest Maj. Wtr. Body
(Scale: ` )
IV
�J
/✓ v� ❑ See note on back regarding River Basin rules.
PermitOfficer's
compliance statement on back of permit'*
Check#

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address.
Phone Number:
Email Address:
'y that I have authorized ` ° I i --'e
A.c_ t Cc^[rocor
to act on my behalf. for the purpose of appiying for and obtaining ai! CANIA permits
necessary for the following proposed development
oroperty located at 4 L
.,`!",_. County.
err;nre certify that ,' am authorized to grant. and do rn fact grant perrniss,on to
n of Coastal Management staff the Local Permit Officer and ti;eir agents to enter
o afolemertioned lands in connection iviM evaluating informatio.? related to this
appticarion
Property Olvner Information:
S%yntu
i
ram, nt or 'ype ;Vane
[hie
This certification is valid through

A JACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby cer!jf} that i own property ad;acent to Nam of Property Ownerl
prQcerty 'ocatec at (Address. I, Block, Road,
i , Ftc'1� t G (N.0
n
cn So we tCity/Toowfn and/or County)
kwaicr uu'w y r
he appnhas as descrhed to me as shown below the development proposed at the above
T
location
` Y� have no objection to this P'opcsai.
t have objections to ;i-s pr000sa,
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawtngi
WAIN R SECTION
,.:ncarstantl that a o:er dock mooring pilings oboan r a ea hfea'ar'ar ah ea h Jn eG ,ftraw ran
n,US L'c, set bac< a ?1 hir"Urn d: stance o /
me if yc�. ssr io waive the setbacY vvu must mitlal t"e ap, rounate blank Le!ev+
do w^�sn to waive the 15 setback requlrer" e''..'.
do not •.vas❑ to wave the 15 setback rge'J''en'e"'
------" - - O er Info ,a I n1-
(Property Owner information)
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(Adjacvt Pcerty Wn
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