Fort Macon Marina

I J .
L CAMA / ElDREDGE &'FILL ( { ' )((No. 75703
A B C D
GENERAL PERMIT `/ Previous permit#
LNew ❑Modification ❑Complete Reissue ❑Partial Reissue Date prey ous 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
( y y [� Rules attached.
Applicant Name i I Project Location: County
1 � 1
� i i �^
Street Address/ State Road/ Lot #(s)
I
_.� f...,
Citv �t (I I I 11 /0 (//State i I i//ZIP ;f^-V
Phone # (";_)J) ' tl(D A x-i-? E-Mail
Authorized Agent
O Cw
l$Ew
PTA El ES [IPTS
Affected
AEC(s):
Cl UEA
HHF
1 El USA ElN/A
ORW:
yes / no
PNA
yes
Subdivision
City
Phone # ( ) _
Adj. Wtr. Body_, --
Closest Maj. Wtr. Body
ZIP
River Basin
- _(nat /man unkn)
....................■......:::'■:::111MEM':::
■■■■D■�r1■■■■■N■�I■■DEED.■.�
■■■■ED',ED■■■■DIM
EEDE■�D■■ ■■■■.
RIMSEMENWO■■■■Ersr�■�
INEMOMINIENi::::::i
■■::i:MM:
11D■■■NINEMME■■■EII■■MEII!i
■■■■DDOEi■�1■■ENDED
■■■■E■■■lli■■■E■
■OD��D■IA■■�1�
■■D■■f9■■■E■■M
E■■■E■■NII■■■■■:US
D■■■■[/�9D116■■i�ED■■IrVMMEM
■■■■■ENE
■■MMOW■IED■D■■G■/,%I■■LAW■�/1■■DEMO
WAPAI
Dr1IADE
■■■■■■■■■■■■■■■■
■■■■■■I�VIr■r!/!II■AN■■N
DEED■
■■DEED■■EN■■■■■E
MEN
■■■�I■aPI_iJ�l/7fN/.r/�IAS�I■EI
■■....■■■N�■■■D
MEN
■■■■■EIiiI�Lr�iwHE■DOWN
■■■■■■.NEE
■NOlt
]"MMI/H■■■►1■■■■
■EON■D=0
■E■■■■■No
MEN IN E ME OMEN
■ENiE:i■■■:DEED■■:■:®:■:::■.:%EENDD
• ■
■:■D■:
■■■ ■DIME■■■D■■
OMEN E■■E■D::.:
D END DIi■ ■Df�QI//I■SE■■■
DOE :NYD .EV�f�►1.E■■■.
■■■ED■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■No
:::::::::::::::::::::.:
::::E 0 IN
■
.NONE.
■■uII NEE::DOE 0 ::: :::::
No
MEN MEMO �m OMEN
No
0..■■:■■■�1■■■■■....:
om MOORE
N■D■■■■■E■E■EDD■■.
Agent or Applicant Printed Name Perm.tOfficer s Primed Name
Si
Ag ntu
ature **Pleasr,,�•ead compliance statement on back ofpermi •r Signature
pp tion Fee(s) Check# Issu�ngDatd Expiration Date'•

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i6 7s ✓ / /,4C&) /YI 4-A i, A 's
(Name of Property Owner)
property located at % C %d �% 1/9Ac r,J /� 0
t9VC-U I SW11.0 (Address, Lot, Block, Road, etc.)
on moo, g, t /JL4w/7 SJauC_-#, in A-Z,,T-ac 13,&,rl N.C.
(Waterbody) (City/Town and/of 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)
DAFiD(ft�l� 9F i}�1��9)C. /5-�O y9- t9P /fl9i�.4AAL
�in oM 14,,/f7- (,A�rG(-� lLoP 14'LdA
RECEIVED
AUG 3 0 2019
DCM-MHD CITY
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)
J
lure
,T��ny A11,#go1,-J .
PAY
Type Name
�t� QotC 312 D
Mailing Address
f}TG ""'rc ,gd.9,-,' '/C
City/State/Zip
.1 A -e20S
Telephone Number/email address
Dat
(Adjacent Property Owner Information)
Sigrl!'I A-,c A a
Telephone jJ` m by mail address
— � _ I1 —1 `
Date �
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
Lt
(Name of Property Owner)
property located at/ % %- %j(�>
QoGur� -5,VL( 0 (Address, Lot, Block, Road, etc.)
on m o v,) y /S1.9� o SlOuc-A, in %.Cr r - N.C.
(Waterbody) (City/Town and/o County)
The applicant has described to me, as shown below, the development proposed at the above
location.
l/ 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)
Opt FcDO t G 9 F ✓�/'1�n9�c. / -'�- -9 L YAn os t9
�n n 14als7-
RECEIVED
AUG 3 0 2019
WAIVER SECTION DCM-MHD CITY
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)
�Sio� i
Print or Type Name
/�i) Q07C �7 D
Mailing Address
n-��
City/State/Z_p
-a2 osS'
Telephone Number/email address
�/� // 9
Dat
l
S5t.19kJ) (o"oNS
tsature* c/ / '
ntd TyV, aa-(¢�t
Mailing Address
IAciw c �C .4c, a SSt 2
City/State/Zip
GIq- CIS
Telephone Number/email address
7Ili llq
Date* -� I
(Revised Aug. 2014)
*Valid for one calendar year after signature*