Kennedy, John

❑CAMA / ❑ DREDGE & FILL It � I � � 78Q➢g10 A B "C ,D
GENERAL PERMIT ` , Previous permit#
4,New ❑Modification [-]Complete Reissue ❑fPartialReissue Date previous permit issued
As authgrized by the State of North Carolina, Department of Enviromrfental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC )` `
1 J ❑RulBs attached i
1
Applicant Name f_. I % y Project Location: County
r
Address Street Address/ State; Road/ Lot #(s)
City State l ZIP 1� ) > �i ! :( f,
Phone # ( i Y )) ; ' / 6E-Mail Subdivision
Authorized Agent City /.t. ZIP /
Affected ❑ CW
AEC(s): ❑ OEA
`U EW ,.\33,o PTA
❑kHF I�IH
ORW: ;'yes / no PNA yes /
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Ripmp length_
avg distance offshore_
max distance offshore
Basin, channel -
cubic
Boat ramp
Boathouse/
Beach
Shoreline Length 'I
SAV: notsure yes`:' not --
Moratorium: n/a yes no,
Photos: yes no -_
i
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditionsj;
❑ ES ❑ PTS
❑ UBA ❑ N/A
Phone # (f `L)
Adj. Wtr. Body �)
Closest Maj. Wtr. Body -
Basin_
(Scale:
❑ See note on back regarding River Basin rules.
. J
Agentpr Applicant Printed Name -., PermitORicer's Printed Name ....
i
Signature * Please read compliance statement on back of permit" Signature_-
�, j
Application Fee(s) Check# issuing Date Expiration Date

'ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
F ^
I hereby certify that I own property adjacent to Jo r,- �h r\
(Name of Property' Owner)
property located at 253S5 A/ 4e I i UNE- '7) ri V e-
(Address, Lot, Block, Road, etc.)
on L%ee,r ('r eke in r'z,e jcsr--erne+ 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
1'
a
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 Information)
gnaturfe
-G7Yi en, rn h e- v
Print or Type Name
3,5— Ale PT u jJ r -D
Mailing Address
G'�oe� r-Ee.,rei'1 NL �`d 58
City/5 atelzip
Clio
Telephone Number
,Tah a.T, Ao z,9
Date
e
Name
+er
Owner Information)
Ca-)1 !4j-;,--1J /ce
Telep one Number
,� eQr 7, ao� cy
Date RECMVS3
(Revised 611812012)
FEB 10, ?020
DCMmR HID MY

+ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 T ereby certify that I own property adjac nt to ro k ri Ke-t'\ K 0 s
- (Name of Property Owner)
property located at 53� N�}i 1 1,�N1= 1�f
(Address, Lot, Block, Road, etc.)
on (7eev free _ in Ce, e (. r " — - N.C-
(Waterbody) (CitylTown 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 hav�objectio_rts_t9 tltiis_pr_olZasal__
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
DOR(AN FecDuc'-r�
4�all �1
7�
Q�'
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 Information)
--ra'. S , o, U ;ZD
Date
(Adjacent Property Owner Information)
Signature i
/=MaL,r-" rDne5
Print or Type Name
r37 AJeP-iiAlf_ 17R
"it) 3`fO aC"_l_.7_u
Telephone umber
TJ 1
0-1
Date RECEOVED
(Revised 611812012)
FEB 1 ®20'l_Q
DCM-MHID c oTr