74798D - Bell

�CAMA / DREDGE & FILL No. 74798 A B C D
ENERAL PERMIT Previous permit #
LWXNew ::]Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As auAorized 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 t1 , ��C)O
❑ Rules attached.
Applicant Name MAR C Project Location: County��.5�... �L
Address_,, /-A M r C ON Street Address/ State Road/ Lot #(s) /-717
City L�0' A-0 State%JL ZIP'1S-3w(P0 Sti' IN a-HC 14 lt� D� -
Phone # (9100 2-1 "730L�E-Mail C N,6C 11 LJ C AAA -Subdivision
Authorized Agent
Affected ❑ CW N EW Ji" PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /c;�P PNA 41�P no
Type of Project/ Activity
Pier ( U
Fixec
Finge
Groh
BuW
Basin
Boat
BM
Beac
Othe
Shon
SAV:
Mora
Phot,
City cJlla.11ot�-�_ zip dL?W O
Phone # ( ) River Basin L„ 1.6..
Adj. Wtr. Body 5K--i t:y< t man /unkn)
Closest Maj. Wtr. Body A \, W
VJ
(Scale: ►J T,S
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i■�■■■■■:�
r pier(s)
i length
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number
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■
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avg distance offshore
max distance offshore—
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■
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cubic yards
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■
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ram
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Bulldozing
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dine Length
notsure yes
FIS: yes ,,n
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MEMEW
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Waive_ r_ _
A building permit may be required by: ��,�..� . 'AA - C-U,✓ i. ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant
Signature Please readcol4iiance statement on back of permit`
Applicati Fee(s) Check #
Per s Printed Nam�____7e
t I:>
Signature
Issuing Date Expiration Date

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
s 2zIVC �,gq
Oy
A. Signature
❑ Agent
X / % ❑ Addre
B. ived Nam iof Del
D. Is delivery address different from item 1? 11 Yes
If YES, enter delivery address below: ❑ No
Il "IIIII I'll III I III II I I III) IIII l I III I III I I I 3. Service Type ❑ Priority Mail Expresso
❑ Adult Signature ❑Registered MailT'"
❑ Adult Signature Restricted Delivery 0 Registered Mail Restricted
❑ Certified Mail@ Delivery
9590 9402 4906 9032 2759 68 ❑ Certified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
2. priirlo Ni imhcr /Tranefar from carvir•a lahwll ❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationTm
❑
7 018 0680 0000 7026 4881 �stricted Delivery R�estritcted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
30
bu rn , �I C 2� 3 �v

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property a (acent to / �•A, �Pll 's
i(Name of Property Owner)
property located at
(Address, Lot, Blppckj �o d, etc.) D
on rC W , in 1 h7A e, /�iQIKAj ck , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
VZ 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)
4 xCAFc1
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.
(Property Owner Information)
i hire
n r Type Name
" /D 7Z'- I✓�T� ic�,,d'r�G I
Mating Address
L���rGr�'�,�i/f
City/Statezpi
�119-- 232 3-�
Telephone Number/ email address
e�.�lrr�yCc's�4kr��.� Cup%"
Date 41-1�1-19
'Valid for one calendar year after signature'
(AdjacerytlProperty Qwner Information)
Signa iie*
Owl'V fx
Print —or p Name
b
Mailing Add
Telephone N7mber/email address
Date'
(Revised Aug. 2014)

x �
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O
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Johnny C. Swift
Plat Book V, Page 259
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Date ReCely d
Date Danoa/tad
Check Fom (Name)
Name o1 Pa H Holder
V dor
Check Number
Chock
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Permit Numbs lC—ft
Ra Wpt or Retund/Reallocated
Columnl
Column2
Cd0mn3
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Column/
cwumns
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Celumnd
columnD
121101=9
SalMa C—f Cmstruc4on Co.
Hdtlan Dwks and. BNkheads {1 al
M.Carlisb _
Tk o y T—,— _
Tt1W+ Thompsm. __._..
South S— Bank
CresCan B nk _
CresCan Bank
11303
400.00
GP 973541 D_ _
PA rvt 73/8
12M W"9
3778
100.00
OP (71797D.
BB M1t BISB
1?/1G2078
Hakkn Dacb aM Bulkheads 2 MZ
3779
900.00
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OP 074787D
BB nx. 8159
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