Joyner, Larry

iaa'�AMA DREDGE & FILL No. 74952 A B 'c D
N6 L PERMIT Previous permit # i 1
O New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality-"J f /� J
and the Coastal Resources Com fission in an area of environmental concern pursuant to I SA NCAC / v
\ ❑ Rulgs attached.
Applicant Name iCy +` '�_ J �� ��� f Project Location: County
ii el,
city ,!
State
Phone # (-:�)t Y E-Mail
Authorized Agent
Affected oew ❑Ew
AEC(s): ElOEA ❑HHF
❑ PWS:
❑ PTA ❑ ES ❑ PTS
IH ❑UBA ❑N/A
ORW: yes'/ no PNA yes / no,
Street Address/ State Road/ Lot #(s) (y
4 �_. J -._ /
Subdivi ion
City IC_ c `t r ZIP
Phone # O River Basin
Adj. Wtr. Body __. _ (nat /man Junkn
Closest Maj. Wtr. Body
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Agent or Applicant Printed Name
Signature +. Please read compliance statement onback ofpermit"
Application Fee(s) Check#
Permit OfOceos Printed Name
Signature'; " 1
a
Isstfieg DRte Expva ion Dij e

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that I own property adjacent ;o _ i y 1' '- rJ "= ` 's
Name of Property Owner)
prop e located at /, 4 v
/9�j�/���p �(Address tot, Blo oad, etcj` i
on �..((�'Y m _.1'�/�YCL-.'J > /.-.,� — 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.
-- -_-- llbave objections to this.proposal.
.N
DESCRIPTION ANDfOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
i
WAIVER SECTION _
1 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. (I(you
vrish to waive the setback, you must initial the appropriate blank below.)
I de wish to waive the 15' setback. requirement.
_ I do not wish to waive the 15' setback requirement.
P. p rty Owner Information) (Adjacent Property Owner Information)
JP
-S Na / - Print or Type- Name
Maidr s Mailing Address —�—^
G"'9 aterzrn ` � S�3 3 cny staterz _
TeleeppJhonne Number Telephone Number
va,< bare _.
(Revised 6/1812012)

ADJACENT RIPARIAN PROPERTY QWN(=(2 §i TE ENT
I hereby Certify that t MVIi (5MPefty adjacent
(Nameof Property Owner)
DroDertvtocated at L r; t r, 6
on
in
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location._
1 have no objection to this proposal.
DESCRIPTION AND/OR DRAWING Of PROPOSED DEVELOPMENT
5 ` (Fndividual praposing development must Afi Irr descdPtIon below or attach a site drawing)
If
rX.,
f ✓ N 4- .
j t�it. li
i
WAIVER MCTIOtj
I understand that a pier, dock, mooring pilings, breakwater, bueflwvse, iitf, or groin must Le set
back a minimum distance of 15' from my area of riparian access uniass waned by me. (If you
--,'r wish to waive the setback: you must initial the appropriate blank below.)
I do wish to waive the 15'setback requirement,
1 do not wish to waive the 15' setback requirement.
arty Owner Informption) � T 'Adjacent Property Owner Information)
1)a(r
(Revised'm b2o^ 2)