Macon, Gerald

AMA / ❑ REDGE & FILL N9 78440 A B C D
ENER L PERMIT Previous ® permit P
ew ❑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
❑ Rules attached.
�
Applicant Name Its �� C� f (t f(r ✓r �', Project Location: County
Address, Street Ad Tress/ State oad/ Lot (s)
State ZIP .? i+ 1�
Phone # (_�)- E-Mail Subdivision
Authorized Agent � City_[ C_'t
Affected ❑ CW VECW �TA ❑ES ❑PTS Phone # ,('f
AEC(s): ❑ OEA ❑ HHF ❑ ❑ UBA ❑ N/A Adj. Wtr. Body
❑ PWS:
ORW: yes / Sid PNA yes / �o `
Closest Maj. Wtr.
Type of Project/ Activity .�C _
Pier (dock) length_
Fixed Platform(s) _
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap le
avg distance o
max distance,
Basin, channel
cubic
Boat ramp
Beach Bulldozing
Other
Shoreline Length
SAY: notsure yes no
Moratorium: n/a yes o I
Photos: yes no
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning jurisdiction)
i
Notes/ Special Conditions i
AA%, n,, I- �..
Agent or Applicant Printed Name
ZIP L; J"V k__�
Basin 11,,l _1 .0 A f ( ( i
%, it (nat m nkn)
J
(Scale: I )
�i
❑ See note on back regarding River Basio, rules.
Signature *' Ilatse ead compliance statement on back of permit" Signature 1
.A'pplication Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /yes o44 L I-A41-&?J I
(Name of Property Owner)
property located at ,3/S 62oD/c Li✓
(Address, Lot, Block, Road, etc.)
on JVn PtvF ✓Zu.✓ eaff K , in Alt U,"rOn,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.
_ 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)
A DA I T/0,,) 0 ic ao9-T Ll F-r To E)dls 77,1 / 1)
.g 0474 FT
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.
Owner Information)
M
or Tvoe Name i nnr or
Property Owner Information)
Mailing Address Mailing Address
CityCity/State/Zp City/StatelZip
.11 � �/-,, 3 o[sz :z�i'-?fro/ RECEIVED
Telephone Number/email address Telepho e Nu ber/email address
/VZM 2 &-f - a%�
Yale oat JAN 14 2020
(Revised IWHD CITY
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LriLi1LD L M&60'n) ,s
(Name of Property Owner)
property located at ,�/Jr .QtioA/c- L4Ne
(Address, Lot, Block, Road, etc.)
on S(LraPI�G �6tn/ C'MZ''/L in A"VWDoaT N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatign.
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)
dDOl-rja�/ t7` Bn7T GiCr
do9-ruGi
� l
io Ex/S—„VG- 1) cc/c
WAIVER SECTION
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.
Owner Information)
or
Mailing Address
.yfw�a I ; .✓L 028'S%0
City/StatelZip
Telephone Number/email address
1110 2-02D
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
rgn�(tune* //�r -
UOk4L 6J i721411 Z'
Print or Type Name
--.?L9 G.cam.4--
Mailing Address
City/State/Zip
Telephone Number/email address
l / 0190z0
Dz RECEIVED
(Revised Aug. 2JAN 14 2020
DCM-MHD CITY