Sea Gate HOA Co Norman Price

ECAMA / ❑ DREDGE & FILL O ,-f.
. 78454 A B �c> D
GENERAL PERMIT Previous permit#
LS3New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality / / i.�.,
and the Coastal Resources Commission in an area of enyironmental concern pursuant to 15A NCAC f ..
©Rus tt leached.
Applicant Name r t2 !]ri t C' (J1� �/ 1 1 : F Project Location: County ( a FCC
n �+
Address PQ l: n17 c )I Street Address/ State Road/ Lot #(s) /
1 1C 7 ,1 City rJ State Z1P
Phone # ( _) 71 C ✓ % E-Mail Subdivision �' /i , c
Authorized Agent i ref n IV f (��� l i t I Cali City ZIP /
i]CW ❑EW -.k3PTA SSE ❑PTS t +"�" Phone# ( ) River Basin ✓1! i �f. I-'r"I
Affected ❑OEA F1HHF ❑IH ❑UBA ❑N/A
AEC(s):
❑ PWf
ORW: yes / no PNA yes / no
Type of Project/ Activity
i
Pier (dock) length
Fixed Platform(s) c��^
Floating Platform(s)�_ O(
Finger pier(s)
Groin length
number �
Bulkhead/ ltiprap length
avg distance offshore I
max distance offshore
Basin, channel
cubic yards i
Boat ramp
Boathouse/ Boatlift
w
Beach Bulldozing��
Other
Shoreline Length
SAM not sure yes
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)q�
Notes/ Special Conditions / v P
1'ICei
;Ir, A111i i I fl 1
Agent or Applicap-t Phrited Name `�"'""^-•-1..
Signature ** Please read comp6hce statem nt on back of permit*
Application Fee(s) Check #
Adl. Mr. Body I , I rl nat man un n)
Closest Maj. Wtr. Body ('% (r �.1 i r < -4:'
/ )
(Scale:l
r � �
B
❑ See note on back regarding River Basin rules.
PermitOffcer's Prinited Name
Sign tur{e/
Issuing Date Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: S'96 GRT,£ d5Sae/p7-IO/V i1tve,
Mailing address:
7a9 So,4 6t91 E Q g tv&
Telephone Number: d2t^a - 707 $ - W076
I certify that I have authorized P12ECI S10N GTLAD,E., (agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of 5&*4 (OAT,. jjeA1L 1)UA
F20*7'7U6 .t/oCKS ~ FUIGL./ < ,e4,4 -Doc,e<
at my property located at %off 9 SXA (:;;;/ITS- PRIu
This certification is valid through
(Property Owner Information)
/ Signature
lV0R'N4NI /l. P%21CFL,
Print or Type Name
t�j2fL5tDEtyT Si.A ,47,E 115So6,U
Title, co. owner or trustee for property
Date
_ a sd. - 7a 8 - aos 3
Telephone Number
(date).
RECEIVED
JAN, 2 4
CC(1 -MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
N,
1 hereby certify that 1 own property adjacent to SEA ( fik 4L5S Ci!}Tlpl i ,s
property located at /p j (Name of Property Owner)
r� 2-�f SEA �At��Y.
�CkA (Address, Lot, Block�, jR�oad, etc.)
on in /Uap rr
(Waterbody) N.C.
(City own 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
(IrMi+rtduelr b► ve .Qp7nen crst/i111n tlesciipaon br for %ar ¢l a site, drawing)
Oa' .
h �o �pCK -t'O 13E" 2C-Pl1)!E19
�o W� � �IOA�SNG= poc.K
y
���� ;3; (Y1ARiwt-1 Stb(zC
s
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse lift
must be set back a minimum distance of 15' from my area of riparian access unler
me. (if you wish to waive the setback, you must initial the appropriate blank below.)
_ I do wish to waive the 15' setback requirement. JAN. 2 4 ZOZO
I do not wish to waive the 15' setback requirement. DCM-MHD CITY
(Property Owner Information)
S,}wnalure r
P nt or Type Name
Marling Address
n
Crty/Sm
Telephone Number/email address
Date
'Valid for one calendar year after signature
(Adjacer t Property Information)
Signature*
Pnnt or Type Name
%s'O S/t/t
Matting Address
Crty/Sta1'
Telep��one Number/email address
n212 /3L
D&O
(Revised Aug_ 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Sen G k A`6S' OC/ A�i Ut i s
property located at / y 2q SCA 64�(Name of Property owner))
fdyC
w (Address, Lot, Bloat, Road, tc.)
on , in_ 1`I ,gL2,r , N.C.
(Waterbody) (Cityown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location .
v �G I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
0POSM9 delreJopmenf nfrisf ir/Ptn _description be(ow ac attach a siue:drawing)
DocK -To -13E i2c->7Lsc�'09
IJ
"vJ
Zv!1 IpA�SNG 70CK
7�CK
L
WAIVER SECTION
1 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 4iL 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. JAN 2 4 2020
I do not wish to waive the 15' setback requirement. I)CM-MHD CITY
(Property Owner
Information)
Si nature
�EA
n or Type Name
Ci sr -a -fa%
Mailing Address
0gC—" r)
Cfty/S�ta
2S'z ta�p1
Telephone Number/email address
Date
(Adjacent Property Owner Information)
_ �_�F
Signatur *
got Cc>oLF_
Print or T pe Na e
Mailing AVYress �i
_ FiELa:tYIY+- AIL /�7 kX rr �yy
Telephone
Date-*
J,I address
'Valid for one calendar year after signature'
(Revised Aug. 2014)