Wheatcraft, Suzanne

INCAMA /JXI DREDGE & FILL
No. 74965
C3i_NERAL PERMIT
'
Previous permit# A B C D
NINew ❑Modification []Complete Reissue
❑Partial Reissue
Date previous permit issued
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
IJ Rules attached.'
Applicant Name I iy, T( We '� l�}I F Ct r
l�` v Project Location:
County_ _ '•r'
Address `j \j c � 4
Street Address/ State
Road/ Lot #(s) r; ilk
City �/l((State_�' ZIP
V
Phone#(��) �— %/'�'' E-Mail
Subdivision
n
Authorized Agent
City
ZIP
j
❑CW nEW El PTA El ES ❑PTS
Affected
Phone# (_)
River Basin
-
"
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s):
Adj. Wtr. Body
/ //� !na /man /unkn)
1-1 Pws:
Closest Maj. Wtr.
rr }
Body �>,._` �;i ( ; r �J(F/!i/
ORW: yes / no PNA yes / no
Type of Project/ Activity
Pier
Fixe
Float
Fing
Groh
Bulk
Basi
Boat
Boat
Beac
Oth
Shor
SAV
Mor
'hot
Wai
(Scale: / ' : �(_.) )
Norm
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A building permit may be required by: f Y�
k,
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
Agent or Applicant Punted Name
Signature " Please read compliance statement on back of permit**
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: it::3 V'Z-IiT� e, hLPsi� k
Mailing Address: R WC.S� oJV+
NC 2321d--
Phone Number: rJ r% l C grl5�
Email Address: 23t/ gf6-V �c���ra TT C �i ijAa U
I certify that I have authorized G` roQ5�, 1-e(y
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _S
at my property located at 5 1 C�
in Cb.v4&�L- - County
I furthermore certify that 1 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:
Signature
�UZ(t ne, �j � -
Print or Type Name
1jl0 VMOWVtev
Title
05 l 9 20i1
Date
This certification is valid through I I

- _ -SENT RiPA-i kN PROPERTY OWNER STATEMENT
(Name of.Property Owner)
property iocatc:' "- w1 —
�J`'erbod`y C (Cityirown andtor County)
The applicant has described to me, as shown below, the development proposed at the above
iocation.
I have no objection to thic nropncM
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 drawlnW,
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.)
_ 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) I
Signature Signatures*
Print or Tvoe Name Print or Tvn . amp
Mailing Address Mailing Address
P� IN` &]c P er+V � � e IVC 2 7 S',SS
City/StatelZtn Cttv/State2io
:ESL- (C)f'C.CCY,LS�.c�(c �5�-3sS-3�'iJls +'eS&Oge
Telephone Number/mail address Telephone Nu bgr/email address SV PN ilk -Yl2 f
2`� —�
/Mlv r)nto *
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to And(ec,3 � &)mt)r)e bjly ac -crair+ 's
(Name of Property Owner)
property located at oZ lt�5f i f "j
(Address, Lot, Block, Road, etc.
on -bbosUe SOUn� in Pine kn^)tt�9-1C)p Cof+ert}t ft. , 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 fill in description below or attach a site drawing)
\,ems Ct,trCcCFV?�,
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.)
/ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjac nt Pro rty Owner Information)
�o(i(o-2�1D$ A�-F lc�rrzed
0i rI1Pn h Re V+
S' nature �� Sign
6P4(G l t POVe f`
Print or Type Name Print or T p t Name
Q ujftt Cnur% VVLIU
Mailing Address Mailin Ad re
,PrrlP e�w,.l,� �.rLc a&51 i� w S,�1JCt 2$SIL
City/State/Zip T City/State
ian..e
g-clogst'w en,��t,�+ it-mn `zY } -�t353, ex' l&
Telephone Number email address J Telephone lyrreer/err�il
Jkre 3 ao t e-4 uj /
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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