TI Endeavors, LLC Co Mohamad Afify

®I)ICAMA / ❑ DREDGE & FILL
GENERAL PERMIT
QNew ❑Modification ❑Complete Reissue ❑Partial Reissue
No. 75791
'D
Previous permit # -
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 ' •�-
m.
Rules attached.
Applicant Name/j -, _ ( AN )AN
Project Location: County 'i
� ���
Address
%.) v
i (
Street Address/ State Road/ Lot #(s) 7
_`
i State/t�ZIP
city
F
Phone # (AO r E-Mail
Subdivision
Authorized Agent ( -i RC
ii)
/
City —AU L
ZIPS_
A` CW _r]EW _dFrA r( ES ❑PTS
Phone# ( )
River Basin
Affected
❑OEA ❑HHF ❑IH ❑UBA ❑N/A
AEC(s):
Adj. Wtr. Body)
/ n (hat_/man junk
❑ PWS:
���(:
Closest Maj. Wtr. Body
T�RI '7.7:7(L CY
ORW: yes / no PNA yes/ no
■:i:::emu:::::■
:..■■■■■■■■■MINMS■i■:..Ii
MEN :■■y�■
r
a no MWOERNMEME
n WOM■■■■■■....
....
■MM..■■MMMMWMMMM
■■I►®■.■■■■■■■■■■■■
■■N
M■■■■E�\IMUMNI■WA
MME■■■■
■MEMO■■■■■
■■■::■■■■NM■av■\1■S►�I,li
d
MEN
■■■■�C■■M■■■■■■
■■■■N■uE■Mir�E
UMMOMMEME■■■■■■
■■E■■■■■■
■.■■■■■■■■■E�:■601,111j9060ME!*E.R°©
MMEOEM■■■■
EELI■■■
M:E
EMEMMENI1f►
MMEMMEMMEEN
\!®NH■O�I■■2
MO■M■■■■■M
EE■
OEM
■
:■■ME■■E
■■ME■MEMMEN11
on
ME
N
MO■■■■■■■■
MawiiMEMOEM■ME■■■■■■■■■®■■■■■■■■\IM■l
M
JIMMMMMMMM
:::::::::MEMOMMIMINI
EM
M:M
:::::::::
S:MOMBI
R
::
aM■■•::■■■■..■.
M■■E■
■■■■■■■■
f!4
NUN■■NNNNa11■■■EM\NN■■■
J■■■E■■MNEEM
■■■=■
M■M►.E■C■.■■■■■■■■■■■
■■■■■■M■■M■:
ENE111MES
■■■■
M■M■EM■M■
MEEMMIM:::MIIR::::MEN■■S■
■
M
M:
■■■SEEN
I
ENEM■■
■■MM■Mo■MEMM
r'�
1
®1:CAIMME
II::::::::::::C�::
M■■M■■■■MME
E■■■
■■M
E
N■
P.
ME
FEEME
'PREEN
a ■
a t
compliance statement on back of permit
7 `t •r
Check #
Permit Officer's Printed Name
Fee(s)
Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 21 Cl tieaoorS, u
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
jj
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: rprPU , ct& (✓
at my property located at I r
in I County.
1 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:
Print or Type Name
f Yl ye n in a'r
Title
lIQ_I
Date
This certification is valid through -4_l-?/ I_402?0

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to / ZAC yz 9 CL G 's
(Name of Property Owner)
property located at for 55¢ Y5-95—
(Address, Lot, Block, Road, etc.)
on in rvoeM( 7VV%i,L j;cW,4
(Waterbody) (City/Town and/or County)
N.C.
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 developrQent must fill in description below or attach a site drawing)
I
i lid/Z rDLGK
.?o
/ZGL
30`
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 Inform tion)
Signature D
Print or ype Name
134/92 Alt P&Uq 60
Mailing Address
�JRF GI d /V L If
City/statelzip
d1igi- '9N-159t.p
Telephone Number
Il�12�2�
Date
(Adjacent Property Owner Information)
1 y�"'rr-
Signature_` pp
1C
Print or Type Name
Mailing Address
C1
tylSfate2ip
Telephone Number
0& 1 Utv
nsrr;
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /Z? -5/29 ,LG G 's
(Name of Property Owner)
property located at LaT h 35 9.5� 1SL2rr4 aP:y 'f -
(Address, Lot, Block, Road, etc.) '
on, ZC��rr✓ in Noel o N.C.
v vc.
(Waterboay) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
p I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Indivipual proposing development must fill in description below or attach alsite drawing)
i �/Z �/2
/yy/y' ,eooi=i
G
30 ,
s� ' 2 c �
/2 6 1C
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
X C*do not wish to waive the 15' setback requirement.
(Property Owner Information)
ware
rn.
(Adjacent Property
Signature
CARL— dAJ HokVAPiJ
Print or Type Name
366 ISL"M Df�>,
Majlipg Address tJ
I) C 7 `�
City/State/Zip
Telepho a Num er
/
Date
(Revised 611812012)
zl4