74517D - Allen (2)

LAMA / DREDGE &.FILL NO 745;17
A' B C(D
�T Previous ermit#`
GENERAL PERM P
ew ❑Modification ❑Complete Reissue, Partial Reissue,,': Date'previous permit issued
As authorized by the State of North Carolina, Department ,of Environmental Quality ` r
and the Coastal Resources Commission'in an area of environmental_ concern pursuantto- 15A NCAG • (�k-�� O� h O� �'�+
Rules attac
hed..
Applicant Name Project .Location: County C� c \c
Address l� ��J Ks ra w kK\.. ` Street Address/ StateLRoad/ Lot #(s)
City. State liL ZIP.'Z��- S t
Phone # ( .) (O y �J�cJ E-AMail GSG �rrj moo Go°^ 'Subdivision . ff
Authorized'Agent (, nSt+E' 'vas City 5+�✓ r (, yi ZIP
Affected ❑ CW pEW p,PTA ES. OPTS 'Phone # ;( q(3) 2(�Z:' ZZ`� River Basin all .tJ:Gk
❑ OEA ❑ HHF ❑ IH ❑ UBA 0 N/A
AEC(s): Adj. Wtr. Body (LGi nc (nat /,roan)/unkn)
❑ PWS:`�
ORW: yesU PNA yes /<O
Closest Mai. Win Body
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Agent or
Signatu a ** Please read compliance'statement 6KSac Hof permit **
ApplicaionFee(s - Y Check#
PermO cee �intd arr�
Signature
p:
Issuing Da a Ex iration Date

AGENT. AUTHORIZATION FOR CAMA PERMtT APPLICATION..
Name of Property Owner Requesting PermitMary—� - A\ev\
Mailing Address:
Phone Number:
Email Address:
certify that I have authorized
Agent I Contractor:
to act on my behalf, for the purpose of applying for and obtaining all LAMA permits
necessary. for the following -'proposed' development:. t x 20 D� z v' .
62! X 11) t E!'��
at my property located at
in �hS'O(� County.
I furthermore certify that. I 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 infonnation related to this
permit application.
Property Owner Information: -
ignature
Print or Type Name
uzAfe
Title
l � Date
This certification is valid through 1 I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to l��( \rjwA 7Ci"sy r , Tr 's
(Name.of Property Owner)
property located at
on %-�� �� 010 a� (Address, Lot, Block, Road, etc.)
in , N.C.
(Waterbody) (City/To n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc ion.
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)
z©,
_V
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
t� me. (If you wish to waive the setback, you must initial the appropriate blank below.)
W- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner nfor atio
Sign ure
rceu
Print or Ty Name f
Ming Ad res
Cif/State/Zi
Am
Telephone Numb e /email address
Date
(Adjacent Property Owner Information)
S ature T g00A leer ��` i l•ldd1E, Tr
Print or Type NamSO k4f\000A
Mailing Address
AAG ) 95-46,
City/StatelZip ,
Tele hone Number/email address
(- 20101
Date
*Valid for one calendar year after signature*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ��l11j enzlf OE. ZddXv�°.�/ 's
' (Name o Property Owner)
property located at ^iQS fS
,11 L (Address, Lot, Block, Road. etc.)
on "i � T fg2 - CO -Oa-` , in S - , N.C.
(Waterbody) (City/Town hndior County)
The applicant has described to me, as shown below, the development proposed at.the above
�/�loc�io
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)
�Dl
(2( x U' �) r e(
ta' x vo, C>A1't')Q0
al
WAIVER SECTION
I updestand 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 Informati n)
Si nature
leap
P('
1�or Ty14SI
ame
���2« �O6C
Mailing Add ess
c i�r_ c215'1 r7
City/SAte0p ,
Telephone um er/email address
Date
Property Owner Information)
Si ture
Print or Type Na e
Telephone Number/email address
� P/� f 9
Date's
*Valid for one calendar year after signature*
(Revised Aug. 2014)

Data Racefved
Date De .sited
Check From Name
Nameo7Permlt Nolder
Vandor
Check Number
Check
amount
Petmlt Number/Comments
Receipt or RefundlReallocated
Column!
Column2
Column3
Column!
Column5
Column6
Column?
ColumnB
ColumnB
7/25/2019
McPherson Marine Services LLC
Suzanne Landis
First Citizens Bank
2651
$ 200.00
GP #74522D
Tmac rot. 8475
7/25/2019
Lighthouse Marine Const/Darrell Erny
Marcell Allen
Coastal Bank & Trust
2758
$ 600.00
GP #74517D
BB rct. 1543
7/25/2019
Martha M and Gary O Pope
Martha and GaryPope
BBBT
7357
$ 200.00
GP #74350D
TMc rot. 9129
7/25/2019
Lillie L Hewett
Lillie Hewett
First Citizens Bank
7905
$ 200.00
GP #74351 D
BB rct. 9131
7/25/2019
_
Backwater Marine Constr/Ted Helms
Bobb Irvin
BB&T
1267
$ 200.00
GP #74332D
TMc rct. 9130
7/25/2019
AB Marina Owners
Anchors Bend Marina
Para on Bank
1 103001
$ 100.00
maiar renewel fee #132-96 Anchors Bend Marina NHCo
PA rct. 9158