Gardner, Robert

^� - 1CAMA / ❑ DREDGE & FILL " NO. 75001 A B C D
GENERAL PERMIT Previous permit#
I'- New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ... A C�
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / d /
' ❑Rules attached.
Applicant Name _- Project Location: County ( .%;9 I /a
Address
CityState, ZIP /
Phone # E-Mail
Authorized Agent
Affected
❑CW
❑EW El PTA
AEC(s):
Ll OEA
❑ HHF ❑ IH
❑ PWS:
ORW:
yes / no
PNA eyes / no
'06S ❑PTS
❑ UBA ❑ N/A
Street Address/ State Road/ Lot #($)
/; Al ,i �-
Subdivision
City ZIP
Phone# O River Basin "rfl
4
Adj. Wtr. Body (� l' i ` inat'yman /unkn)
Closest Maj. Wtr. Body —
I;
Sign t re"�Please readeempliancestatement onback ofpermit"
_. X- (-
id placation Fee(s) Check#
PermitOffcer's Printed Name
Signature
Issuln ate Expiration Date

Town of Swansboro
Friendly City by the Sea • Established 1783
Andrea Correll, AICP
Planner ENI O
eo
Os- '
601 W. Corben Avenue, Swan.rboro, NC 18S&l
Phone: [phone] • Email: acorrellGd I A n s

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Tj U Fl r, 94i <? dl7 's
(Name of Property Owner)
property located at L7L 1 S
on
in
etc.)
N.C.
(Waterbody) (CitylTown and/or 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 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
o
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
I do wish to waive the I & setback requirement.
1 do not wish to waive the I & setback requirement.
(Property Owner Information)
"acent Property Owner Information)
Signaturel*
Si e
Print or Type Name
Print orType Name
L-u sh��?y
N-/'e— S
rlN
Mailing Address
_Sc�,a,-.,.✓,rr-� iV
Mailing Address
6 o/ W G u R (�ZZ/ 140E 2'3SY�l
Ci4Mate/Zip
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CO)SWeMp
6? l()--3:1 6-L/-�f-� Y
Telephone Number/email address
p
Te ,1Numger/email address
� h,s/zq//9
Date
(Revised Aug. 2014)
`Valid for one calendar year after signature*

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to lam' 1 a F3f 7z T 's
,A (Name of Property Owner)
property located at
on
(Waterbody)
(Address, Lot, Block, Road, etc.)
in .5-4 / < 29 J R Z=2 , N.C.
(City/Town and/or 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 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
j�1/F �1d�t�l }??X f►t ` t}p�1 LI ii ddscrrptton b lr dr attach a srfe GII fil
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Infor tion)
Signal re
IR n �y`1 -T GA RDW�t�
Print or Type Name
Mailing Address
City/State2ip
C1 sy— 5"40
Telephon Number/email address
�l2 L 1(20 1 R
Date
*Valid for one calendar year after signature*
( a ntPropertnerInformation)
r
2
i rro�j�, Jrn�Lioa
Print ). or Type Name o
�
Mailing Address
<' /v G a sp �XiG
City/StatelLip
Telephone Num9er/email address
�ab � S'nr1
Date*
(Revised Aug. 2014)

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