Paul, Alvin & Linda

®AMA / LL DREDGE & FILL No. 75911
^ A B C D
ENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As autho ized by the State of North Carolina, Department of Environmen I"Quality
and the astal Re so rc Commission in �n area of environmental conc rn pursuant to 15A NCAC -
❑ Rules attached.
Applicant Name f i Project Location: County
Address Street Address/ State Road/ Lot #(s)
City State ZIP
Phone # ( ). E-Mail t✓ Subdivision
Authorized Agent _ City ZIP_
Affected ❑CW "'t EW ` PTA ❑ES ❑PTS Phone# ( _.)_ River Basin
AEC(s): 71 OEA �iiHF + IH ❑ USA ❑ WA Adj. Wtr. Body _. (nat /man /unkn)
❑ PWS:
01 W:: yes / no PNA yes / ;no Closest Maj. Wtr. Body-_ - - -
Type of Project/ Activity
No 0C:
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Agent or Applicant Printed Name
t
Signature "Please e read compliance statement on back of permit**
Application Fee(s) Check#
Permit Officer's Printed Name, .j
Signature
rlle'iiq�66 gin
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to Rey 1N & U%bA T p
\)k- s
(Name of Property Owner)
property located at 1001 L\SVOA Qi[. NgWpon NC cgs-) �L4- aaa)
!2 Z `wc SOU�(Addresn, Lot, Block, Road, etc.)
on �J _XJgG W PO4LT I C.A 52.TF RAT , N.C.
(Waterbody) (City/To and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati n.
M
I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
RECEIVED
NOV 04 Z019
DCM-MHD CITY
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 Info tjon)
Sig tore
H�v1tJ qyL—
Print or Type Name
toe► ) %rJDA C�_
'�'t� wec sz; . cvc ag5�t
C /Stat ip
� I ac�3-lga%4
Telephone Number
%o1A(A Its
Date
(Adjacent Property Owner Information)
shwture ')RmE5 (31 g(MSON
Print
or I �Type3 NYmg H/�
vr-
Mailipg Address
Coiaot/F.K) )UC aP6/3
City/State2ip b.�S,�LN���NO
Telephone Number
I�la9/i9
Date
(Revi5ed 'iR1201??
IN iu wP6-g ��C�

RECEWED
NOV 0j
DChl-NIFID CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ' I;x 'I N & l f N D fl f �1�,�+i- 's
(Name of Property Owner) ►s� _ aA��
property located at 100 iINflA GT. N t>aPt�( NG afi',5-?D
(Address, Lot, Block, Road, etc.)
on � C L Lei �C u in N w �d 0.Lzr I C<g TC Rt1� T , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
x_ I have no objection to this proposal.
I have ohj�iiorl-s_t-o ths_pr_apnsaL-.-----__-
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
S t k5 �A C'*)I�D
RECFIVFD
NOV 04 2019
')CIA-MHD CITY
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 Information)
Sag ature
Print or Type Name
)t7ce L�wy,A
M\\ngAddPesc2 i W, �A5Z�f
(Adjacent Property Owner Information)
Signature v U
A,4 / r+n -'Te c. c,EY'
Print or Type Name
342_i µ 66-V S iyo i�cNp
Mailing Address
DI,yState ` City/State2ip
d.CA(as 80�,� 2���res F, ,Nc 12- &13
Telephone Number Telephone Number
-�� la [2'z 11a1
Date Date
(Revised 611812012)

RFCEIVED
NOV 04 2�19
DCM-MHD CITY