Madden, Carol

L�J®❑CAMA / ElDREDGE & FILL No. 75723
—. A B C D
GENERAL PERMIT Previous permit#
New [:]Modification❑Complete Reissue ❑Partial Reissue` Date previous permit issued
As authlized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Comm' sion in an area of,envir'onmental concern pursuant to I SA NCAC
,i ❑ Rules attached.
Applicant Name i �:� G l roject Location: County l
7:/
AddressStreet Address/ State Road/ Lot #(s)
/ %..
CityState V ��ZIP >
Phone# Or(tj�f' I r .� t E-Mail
Authorized Agent /
Affected fACW �of PTA ❑ES ❑PTS
AEC(s): lOEA E1HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes /(o^r)7 PINA es /(nV
Type of Project/ Activity
Pier (dock) length,
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshc
max distance offsh
Basin, channel
cubic
Boat ramp
Beach Bul
Other
Shoreline Length T7 f
SAV: not sure yes o
Moratorium: n/a yes d
Photos: yes no
Waiver Attached: yes �o
A building permit may be required
( Note Local Planning jurisdiction)
Notes/ Special Conditions _
f F!l.. 1,, t
Agent or Applicant Printed Name
1
I
Signature .+ Please read compliance statement on back of permit*s`
Application Fee(s) -Check#
Phone #
Adj. Wtr.
Closest Maj. Wtr. Body
ZIP
River Basin
(, 'i�nzt
(Scale: _
See note on back regari
i
/!'l
(< °X '
PV1(fi
Basin rules.
Permit Officer's Printed Name i
ii
Signature
Issuing Date Etxpiration Date

ADJACENT RIPARIAN PROPERTY OWNERSTATEMENT
1 hereby certify that I own property adjacent to ��✓� �la���r. s
(Name of Property Owner)
property located at � h�
(Address, Lot, Block, Ro$. d, etc.)
on tti rj'G �i ✓e ✓ in /1l uT /t' N.C.
(Waterbody) (City/Town andlor 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
(individual proposing development must Till in description below or attach a site drawing)
Clock c�,15 ce 1��stit'
jq( S)iuk I) 1'
il4(tdda—
�wpVd (�
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, In, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (If you
wish4o 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) (Adjacent Property Owner I formation)
./� iGi Gii
Si tore.
w )
( ' I�QC/ClP/1
PT,-,,
rint orTy a Name
�S7/('J Pt )nUfi ��nS
--X1 g MVx VA 23 2 33
Cit//ytt/StatelLi wy-
Telephone Vumber
�l iU )20/GI
Date
Date
"o
/41/'7
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4'u�C(c t ` s
(Name of Property Owner)
property located at / %S S J26'%( /) V�
(Address
on A/Y/ti ✓e ✓ , in
(Waterbody)
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.
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)
i
CiocA- 5tr u:�l, I�
pe:'fiwn CPu.�P✓
Ici � SjlLlt l
f �cctaCk
WAIVER SECTION
I 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. (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)
7S' �tture
Cu l ✓i�Ct�CPr')
Print or I Name „
Mat tag Address
PrChravwl' W LZ 13
City/state/Zi
611MY--l6m5 _
Telephone umber
Date
(Adjacent Property Owner Information) /
'-;;; Lr C- K""
s- ACAS
Hai Kt
J<1 ,IC&
r�
Print or Type Name
MeAddress L
N� �,a•0�6�
City/state2ip
Teleobone Number
_ O _rs"12 7
Date
(Revised 811812012)

V /�
4)e,zlw.
i ' cu ix-
Cl C (7, l ,S h� �� �r, 4&LA i .L
�� rv� �ll w,., 1 �J t { �,,- ✓� tom' �3/yir�'��, ��

CAMA / ❑ DREDGE • FILL 12 / ©909 A B !,•'C... D.
GENERAL PERMIT Previous permit#_
i4jNew--
'_1Modifkation OComplete Relssue :PartialRPt(ssue-," Date previous permit issued
Asauthorired by the Sete of North Carolina, Department of Environmental Quality -
and the Coadal Resources Commission in an area of environmental concern pursuant to I $A NCAC _
Applicant Jame ,, Project Location: County_..__
Address r_ :__, _. -x Street Address/ State RoetV Lot #(s)
y l . 7
City, !_•- I "� ___Stare ZIP .�)a•.
Phone #( -_iy ) �.E-Mail._ ___.T-_ Subdivision
Authorized Agent -.. ... _ City_ ., ___.._ ZIP
Affetted '.: ': EW ;PTA IES PTS -- Phone # ( '1 River Basin
AEC(s): L oEA HHF IH I Lan WA Adj. Ww. Body(at !mgn iunkn,
PWS'
ORW' yes I no PNA yes ! no Closest Mai, Wtr. Body
Type of Project/ Activity
(Scale: )
PW(durk)k Vtn
Feed Pladorm(s).. _ 1
Fkweng Pladormis)
Frnger pier(s).
Groin length
'dVg dlStaMe O115hOre__. _ - -
max dannre offshore.., � '�
awn. dranna ..
cubkyyds .. -
Boar
Boathouse! Boaddc -
Beach euadod.j
Omar - -
r
I
Shordue Ucgth ._. d
SAV: sera yes n
Msxaredumt Na yas j
Photac yes ne
Wai rAtached: yes no
A building permit may be required by: i -See note on back regarding R, - , Brim rule:.
( Note Lod Planning Jurisdiction)
Notey Special Conditions
Agent w Applicant Printed Name
' Srgrature , Please readcorsap;iance stacememon backof permit ea
Apprio4 nFeo(r)UMkk
Pell 11`�4

ADJACENT RIPARIAN PROPERTY DOWNER STATEMENT,/
I hereby certify that I own property adjacent to ` n ro .Cc-��FN 's
/ (Name of Property Owner)
property located at %9 Sfv r F L'r
r� (Address, Lot, Block, Road, etc.)
on in _of"U 4. r'f— , N.C.
ater ody) (Cityrlown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca'
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)
!9�_ _i.re)7r
'M,ga d E e)
WAIVER SECTION
I 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. (If you
wish to waive the setback, you must initial the appropriate blank below.) - - I Vy
I do wish to waive the 15' setback requirement.
not wish to waive the 15' setback requirement.
(Property Owner Information)
KI J -is 1 C�✓1�
A se—"j-
(Adjacent Property Owner
-AI )
�f/f:Gz;,.�.t/. ems::..
Print or 7y /Name i
X — /Y 9 .�i o.-.e.
Mailing Ad s
ity/stat
5'- 5`!
y eleph ne Nu er
(Revised &1 aQ012)
_ Ile -0 ;cc4