McLaughlin, John

®❑CAMA / ❑ DREDGE & FILL O. 75282 A B C D
GENERAL PERMIT Pre iouspermit#
ONew ❑Modification ❑Complete Reissue ❑Partial Reissue Date�revious permit issued
As authorized by the State of North Carolina, Department of Environmental Quality y ;
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC / \
❑ Rules attached.
Applicant Name ti I 1 / \ Project Location: County
Address Street Address/ State Road/ Lot #(s)
City
State ZIP
—
Phone # (._. )_
E-Mail
Subdivision
Authorized Agent
CityZIP
❑CW
PTA ❑ES ❑PTS
Phone# O River Basin ' •. -"`-
Affected
_J�EW
AEC(s): OEA
❑ HHF
❑ IH ❑ UBA I N/A
Adj. Wtr. Body n (naOlman /unkn)
-
❑ PWS:
I L!
Closest Maj. Wtc Body
ORW: yes /; no
PNA
yes / no
Type of Project/ Activity
Pier (
Fixed
Float
Finge
Groff
Bulkl
Basir
Boat
Boat
Beac
Othe
Sher
SAV
Mon
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A building permit may be required by:
( Note Local Planning jurisdiction) Notes/ Special Conditions IVA
Agent or Applicant Printed Name ! /
Signature ""' Please read compliance statement on back of permit"
Application Fee(s)
Check #
PermitOfficer's
Issuing Date
❑ See note on back regarding River Basin rules.

I1eo5e,
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � a h /1 cL2 t a411 ' s
(Name of Pro erty Owner)
property located at /&-V- Cq t-1"&Q x2�
77�� (Address, Lot, Block, Road, etc.)
on 1 k,an toS Cv e- f- k in 5A g4, N.C.
(Waterbody) (City/To h and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatiop-
1 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)
CNn-{' �4 S�4(�� Y�2��9�Pi 0v/j1-�`'2i✓ �x SGIhp,G-f'lUglrn�(' �oc�� �nCX cL��
cic'e02 -ti0'"��a9 n dC-oC� Rva�tiKpi Ootti�i /�d ©f 2x S�lt�� �o$� ��'i s,
• a s, • 00
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• w d ao
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m e k
ra iy
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fixe t;Ex,`sti
PdC°;'P v
�
D o f- Jul 2V
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.)
�c 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 Information)
t -7;7 �-
ignatur•e
-a'4H ltii�L��
Print or Tvoe Name _
Telephone Number
Date
x
�s - 2Hs-' 4V-U
Telephone Number
Da IC 1 )b'C,
(Revised 6/1WO12)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that 1 own property adjacent to _J v k n, /y! `Lg s
/n� r� (Name of Pro arty owner)
property located at �R. wctGc� L2�
(Address, Lot, Block, Road, etc.)
on_.�kffi S Gv �� in, 'h2gc�s Fe-y_,_ �vist`o�J N.C.
(Waterbody) (Cityfr 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.
'l
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must d(t in description below or affach a site drawing)
(wof (b sc-49 gp-PAC-eiOL, P-krgt v' e.x Sr/ M'C ` o95nP cooCk 9ndt a�
C ndoQ,-tiC;K l �oq n-� rKoGE!
C-KLt�
v
B
6V.
V
<
( n q-% Sc.k ✓ 42
Yi UKE 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 mast iollflall the appropriate blank below.)
�c I do wish to waive the IS setback requirement.
I do not wish to waive the 16 setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
ignarure Signature
7:3-4 kf1 L1-1�/fl E4rnes�
Pnaa n_t or Type Name Pima or Type Name
(: aa90 sta�jt�0.�d �d.
Mailing Adovss r ss
Styepp%�C1�Yr� S0.le /U.C, a%JS
CI -!� 9
Telephone Number Telephone NurWer
?41 CS' a[a - [9
Date `- Dare
(Revised 611WO12)