Sutton, Mike

L1 CAMA /.*'DREDGE & FILL No. 75748 A B C D
GENERAL PERMIT Previous permit#
New ❑Modification []Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality `/. % 1 �:
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7
(DRUIes attached.
Applicant Name Gf ; / Project Location: County 6— E
Address �'( 'i `! , C Street Address/ State Road/ Lot #(s)
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City "r i State�,jl ZIP
Phone # O �� E-Mail
Authorized Agent
Affected ElCW bEW CIPTA —LIES ❑PTS
AEC(s): ElOEA ❑HHF LJIH ❑UBA ❑N/A
❑ PWS:
ORW: yes / no PIMA yes / no
Type of Project/ Activity
Fixe
Float
Fing
Groff
Bulk
Basin
Boat -
Boat
Beac
Oth
Shor
SAV
Mor:
Phot
Wai%
Subdivision
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Phone # ( )T River Basin AJ F
Adj. Wtr. Body C (p�(nat /T)/unkn)
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A building permit maybe required by:
'l- 41
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� See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
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Notes/Special Conditions
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Agent or A licant rimed Name
��P ,
Permit Officers
Printed Name
y-
Signature 'ts'Pleasetddcompliancest
ementonbackofpermit'*.
Signatu e
,ya
Application Fee(s)
Check #
Issuing Dat6
Expiration Date
I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to m I SCE S Uyyu rJ s
�s (Name of Property Owner)
property located at I4 6<-`2 TRy�6C -44A/C i
(Address, Lot, Block, Road, etc.)
on Qil �p F,�< in cA4 < c� E r co. 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.
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)
az
;!n
II
� fi
17
k
1'd/_1VA=1:Jl&11*W6JIL
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.)
—F 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
(Adjacent Property Owner Information)
lqig:atzVeu
SCFT-
Print or Ty a Name
/00 go X ao GI/
Mailing Address
pV)K)Te:2V ILIC Nr— 2fsSc)
City/S1 ate/Zip
Cas.2, -7/4- 66s`7
Telephone Number
/O )-ZUlC%
Date
(Revised 6/16/2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Y(ede<-k0k'M.Sv``4pk 's
(N e f Property Owner
property located at , '&_9 IgI All ��
(Address, Lot, Block, Road, etc.)
one Cre-tk ,in_�c�� e� (Co��a , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lo9tipp.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
Ji"I h'f4;V ** *1'k
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.)
�7
/y J I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
oigri"I"re
�re�"P lck
Print or Type Name
02 jo.TS J Cah'g be
ailing A�c�(dress
. 1, s F0 . r%/f' l
ity/State/Z'
�/d— /3113—
Telephone Number
Date
Print or Type Name
Mgi(ing Ad�f�s
City/State/Zip
Telephone Number
FPTI ;
Owner Information)
(Revised 6/18/2012)

I hereby certify that I own property adjacent to I y \K8 2-A4-2-�A/ 's
&AA Ni P I i i (Name of Property Owner)
property located at
on (k (Addresrs, Lot, Block, Ro�d,fgtc.) n N.C.
-(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
fi'm, I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
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.)
S-M- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Adjacent Property Owner Information)
i.
Si ny ure
�One.�"hH'1. /�• /'ice-.S�n
Pri t or Type Name
Mailing Address
W,,/,shy z-oe'3-7��
City/State/Zip
ZS�z Zy/-C 0.3`1
Telephone Number
/0 - Z- /�
Date
(Revised 611812012)