Lewis, Darlene

®n CAMA / 4REDGE & FILL No. 75945 A B ; C D
GENERAL PERMIT - e Previous permit#
❑�ew ❑Modification ❑Complete Reissue El 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 I SA NCAC
❑ Rules attached. /
Applicant Name _"""FJ -� Project Location: County(i z
Authorized Agent
Affected ❑CW [J EW 'PTA
AEC(s): ❑OEA HHF ❑IH
Agent or Applicant Printed Name
S ❑ PTS
❑ UBA ❑ N/A
Signature "Please read compliance statement on backof permit"
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s)
Subdivision
City V� :1 zip
Phone # ( �) _ ' River Basin
Adj. Wtr.
PermitO ficer's Printed Name .
_(nat /man_/unkn
Signatur
�iIz/g
Issuing Date
Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I )", Cr�P �-a i i 5 s
II (�N me of Property Owner)
property located at �� ttb�lut Ln J �o+ c44 G5
/r Addre s, Lot Block, Ro d,
on CCt(iQ `SOLI �IIPtt)su�lYjvl h �tei C122A 2TCRt✓i' N.C.
(Waterbody) City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc9n.
I have no objection to this proposal.
-_-- -- -._-- _ I have oLjQcfi_ons to-this_proposaL---------.---
�R
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must till in description below or attach a site drawing)
9ttal 5ow)dy(eu) LnA Caocd
0
' ,ob'onco-nu
3 9 R
1u
(y"4a0' a b g5egeCn WAIVER SECTION_--
ders a d at a pie , 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
0 ,t.ULf�
Signature
ahlene. GIs
Print or Typ i Na O
M,il(n Address
s w 5 l D
CiltyylsAtJe/zZ)
��a-au-►-gd1-I5
Telef 1I U �l um
Date ' I 1
(Adjacent P
L)tgnaVe
EIVED
(Revised 611149810 2019
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to JRIPRP IBC 1�16 s
( '' `` (Name of Property Owner)
property located at ��J NO��U /poi C"74- CS
(Add ss, Lot, Block, Road etc.
on Canal g1'eib" cU n& stb�n �j el Poa� ) 1%�� e+ N C-
(Waterbody) (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.
_- -----h&ve—objecti-on-s-t9 this_propos-aL-------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual prop
developm�nent mu t fill in description below or attach a site drawing)
Ce�rv�l
,King bur)dl J 1 eu)
QD
P
�-- O
P �
_. )r(up(d �tVpeLrG a5wo WAIVER SECTION
I er tand chat �er, oonng pilings, breakwater, boathouse, lift, or groin must be set
ck a minimum distance of 15' from my area of riparian access unless waived by me. (If you
ish 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 Information) (AdU'#cent erty Own r Information)
4(R.
L)are
Print or i yre tvame p�
M il' g Address
City Sta e/Zi
Telephone Number
// /'(0 //9
I.,
RECEIVED
(Revised 611812Wh O 7 2019
UCM-MI-ID CITY