Long, Richard

i ;CAMA / ❑ DREDGE & FILL NO. 75294 A B 'C D
GENERAL PERMIT Previous permit //,
A
❑New ❑Modification ,FComplete Reissue ❑Partial Reissue Date previous permit issued r '
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 '? /�! / - !r..�
i f3Ryles attached.
Applicant Name fi 7t t y / r,,? 1 Project Location: County
Address I—� �F,
\ ^ � t � � 1 Street Address/ State Road/ Lot #(s)
City ��'l '� State ZIP
Phone # ( ) ' ! E-Mail
Authorized Agent
Affected L�CW ❑EW LJPTA OES ❑PTS
AEC(s): ❑OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA .yes / no
Subdivision
City '- I ZIP 1�
Phone # O River Basin
Adj. Wtr. Body `�''l-r� l �!':'� f � ' � � (nat /man /unkn)
Closest Mal. Wtn Body
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:��iCii■iiiiiiiiiEMMEME::
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit"
Application Fee(s) Check #
i 4)
Permit Officer's Printed Name
Signature
Issuing Date Expiation Date

ONLAMA / ' 'DREDGE & FILL , ? 1079
ENE PERMIT Previous permit # A e C
Asa,010
ew { !Motflfiratwn Complete Reissue 71)artkal Reissue Nte previous permit Issued t�
fit, by [he State eof Nattb Caralirta. t?'epanrmmit of Environmental duality
and the Casual Resources Comprufmon In an area of enviromnantal concern pwsuant to I SA NCAC
t `�, '7^ 'Rules attxhest.
AppGeantName_�}i� PrgjeetLoeaton: County-
Address,._ � ...: � Cv k Street Address( State Road/ Lot (s)
aty ��ylr{�. ------ tI�__ sate � zip 0--- I b� 1 % tt� �l -- .. t
Phone # PP)�(l2#�OE-Mail . - Subdivision . .
Awhorixed Agent _.� ftvj,. GOhi City--s `� -- t r _ Zip ?At� �fSo.,c'�},
Affected -,CN Y1(J:W WTA J#S _-PIS Phone# {....�1 '�- PBasln�d'he.(• O'L
AEC{s} ;' 'ttHF :1N 'USA tyA Adj. Wtr. Body t aa'L� .) oat- aT AIA
.i PMS: pt
ORW: yea �<' PNA no Closest Mal. Wtr. Body -.i °' f' ✓ys.------- -- -
1'ypa of ProjeWActivity
Piee (dock) fen$h.
"Hadorm;i;.,
W,khrz&
11WY 4iSIdnCC tl(lfiw�C
grim, dreesel
cubic yards... --
Beach NulSdoKot -
other 11
(Scale:
f��•� LaPS
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i
5AY, rMwn. yes
rtoratorum: nfa yes no ... r
Photos: yes no
Waher Atfadzed, xs i .. -__ .._...... - ....... _. .
A building perms may be required by: ._.- l... Sec note on bxk regarding River Basin rules.
( Now Wcal pianetngJurisdtcum)
Motes( Special Conditions _
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e �.
led ame 0 P mi (IK� f Pnnt9d NdmE
`Pfentereadrorr�3iancestatementonbac3to(parrrrEtv'/„; Sign u
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(s) Check x i )IssuvrgDate - ------^-ExpimtmOate

Om
CC
Page _ of
Date
-----
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VEMM-Sm"

I hereby certify that I own property adjacent to Rl ( [Vir j 1- ' M i- hefhYl f l (_1 T�--J n-r s
property located at
on _ _(r (_t) , in
(Waterbody)
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location. }�,
-� rave no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must Hit In description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dodo, 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.)
Dare
I do wish to waive the 15' setback requirement.
not wish to waive the 15' setback requirement.
D
Nalid for one calendar year after signature'
(Adjacent Property
(ReWsed Aug. 2014)

k)
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i 's
(Na of Property Owner)
property located at I D� 1 t k'l�l LE11 GK 7%1 / t e i i i VP ,
(Address, Lot Block Rom, etc.)
on , in n cflj rr'1-I-U N.C.
(Waterbody) (City/Town d/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca�on.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill In description below or attach a site drawing)
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.)
ware
I do wish to waive the 15' setback requirement.
:— I do not wish to waive the 15' setback requirement.
owner Information)
*Valid for one calendar year after signature*
(�� Property r Information)
(Revised Aug. 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address;
Phone Number:
Email Address:
I certify that I have authorized
shard
LL4 °-
&-+Ixlncl
'laot
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my /�p�ropertIt,
located at r
in IT`) f t, U) County.
I furthermore certify that / am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
✓ (-
�Y1 Signature C,
Print or Type Name
`k1JtUc-V'
p Title
Date
This certification Is valid through I
rry

Connell, Brad
From: Connell, Brad
Sent: Friday, October 11, 2019 4:14 PM
To: Parris Tipton
Subject: RE: [External]
Importance: High
As long as the pier access doesn't exceed 6' wide, this configuration is permittable. I'll modify the permit to reflect this
change.
Have a nice weekend,
Brad Connell
Environmental Specialist II
NC Division of Coastal Management
httD://oo rta I. n cd en r.o re/web/cm/d cm-h o m e
[phone] ext. 214
[e-mail]
W- Nothing Compares
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties.
From: Parris Tipton <[e-mail]>
Sent: Thursday, October 10, 2019 12:27 PM
To: Connell, Brad <[e-mail]>
Subject: [External]

Parris Tipton
Direct Sales National Accounts
704-907-1376
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