Tuttle, James

❑i8AMA % DREDGE & FILL
GENE , , L PERMIT
CNew ❑Modification []Complete Reissue
No. 75249 A B C D
Previous permit #_
Date previous permit
As authorized by the State of North Carolina, Department of Environmental Quality a+ • "
and the Coastal Resources Commission in an area of environmen al concern pursuant to 15A NCAC Rules ) attached.
Applicant Nam 1 i. l !/. Project Location: County_ _
Addressr _ WI ; ; ~� Street Address/ State Road/ Lot #(s)
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City, j .f (�{/ State I ZIP
Phone # O (( E-M il+a`Subdivision
Authorized Agent l k ! City l( J i ua i (3 ZIP
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Affected ocw EW TA ❑ES ❑PTS Phone # () River Basin
AEC(s): ElOEA ❑HHF 1 ❑UBA El N/A Adj. Wtr. Body i// (nat/man/unkn)
❑ PWS:
ORW: yes / no PNA yes / no
❑Partial Reissue
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Agent or Applicant Printed Name
Signature**Pleasereadcompliance statement onbackofpermit**
1 lr -
Application Feels) Check#
PermitOfficer's Printed Name j `Jt
Signature (
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY ONVNER STATEMENT
(FOR A PIERAV100RING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
I
,JAYW S l c) 1Lc
S
(Name of Property Owner)
property located at �a'� CIMNL: VIZ V'l C�/
(Lot, Block, Road, etc.)
on G(JG SMUAJ p —,in CAPL C/$eZZ 4C : % N.C.
(Waterbody) (Town and/or County).
He has described to me, as shown below, the development he is proposing at that location,
and, I have noobjections to his proposal. I understand that a pier/mooring
pilings/boadift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
of riparian access unless waived by me.
I do not wish to waive the setback requirement.
N XA -
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developmen '
-2
Vi
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RECEIVED
AUG 14 2019
J?oya-Lr; 1',94-t\1 1
Print or Type Name
,_J_S�, 393 �,3
Telephone Number
OCM-MHD CITY
Date:

ADJACENT RIPARIAN PROPERTY ONVNER STATEMENT
(FOR A PIER/MOORING PILLVGS/BOATLIFT/BOATHOUSE)
t
I hereby certify that I own property adjacent to J� �r 7 LL= s
(Name of Property Owner)
property located at d-JL-1 Ct-�uNC=/- VIC-W
(Lot, Block, Road, etc.)
on SO&OC- S00A/D in CAL C4CZ4LE-% N.C.
(Waterbody) (Town and/or County),
He has described to me, as shown below, the development he is proposing at that location,
and, I have no objections to his proposal. I understand that a pier/mooring
pilings/boatlift/boathouse must be set back a minimum distance of fifteen feet (15') from my area
pf riparian access unless waived by me.
I do not wish to waive the setback requirement.
I dja wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing developmer�A
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UNaC215a,�T ur�1 VI tv G/ V1
AtJ-6 OUT TC> a` y 2
GI I R NnI /_-L I
80c uC' 5f%U1'JL
RECEIVED
AUG 14 " 1
DCM-MHD CITY
( JPHf457nA(
Print or Type Name
! ', 7.2-S 33 "3s
Telephone Number
Date: