74624D - Brown

�. CAMA / DREDGE & F14L No. 74624 A B C
GENERAL PERMIT Previous permit#
;i�NeW ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resqurces Commission in an area of environmental concern pursuant to 15A NCAC
_ / lets attach
Applicant Name %✓� G Nl� G f� Project Location: County
Address e / If JU641Y Street Ad ress S�ftate Road/ Lot #(s)
City State_/ ZI�PII.S�61 4� 44 P"?/
Phone *q 0 7 2IS y E-Mail Subdivision
Authorized Agent eE City z,-t ZIP y
Affected ElCW Aw WTA
❑ ES ❑ PTS Phone # ) Rive , asin
AEC(s): ❑ OEA ❑ HHF lH ❑ USA ❑ N/A Adj. Wtr. Bod- 4 10 nat unkn
❑ PWS. 7
ORW: yes /,io PNA yes
Type of Project/,Activity
f /h
Pier (dock) length
Fixed Platform
Floating Pla ) l
Finger piers
Groin length
number
Bulkhe / Riprap length
avg istance offshore
max tance offshore
Basin, channe
cubic yards \
Boat ramp
Boatho e/ Boatlift
Beach Bulldozing \
Other _-
Shoreline Length otr
SAV: not sure yes no
Moratorium: n/a yes no
Photos: y no
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Signature Please read compliance statement on back of permit **
Application Fee(s) Check #
Closest Maj. Wtr. Body ,% �// we /— C >
❑ See note on back regarding River Basin rules.
Name
Date
6� 3 • Z
Expiration Date

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, secretary
Date 9 - // - /9
Name of Property Owner Applying for Permit:
Mailing Address:
ZO 4/ Z .S /OC4: of It e a W k d.
I certify that I have authorized (agent) /V Al `oq%,vra+� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) ,e d 1-2 / 0 o cA c / , .�' f ,
at (my property located at) k 7o,PSq:/Bete )VC.
This certification is valid thru (date) 11- J 1- )-Z)
Property Owner Signature
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper

�7) -2-s- /�-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to V' {F�rP-,.,� Is
(Na of Property Owner)
property located at &E,2 171 f-J 17 h11_
on 7tJIlt—k
(Waterbody)
(Lot, Block, Road, etc
in 7 , N.C.
Town and/or County)
Applicant's phone #: / 10 3 � 7 02t Si Mailing Address: Z Cif
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
-------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT: ---------
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
gI t7� Gf
Mailing Address
City/State/Zip
0
Telephone Num r
Signature Date
C sf 44 ._
(Riparian Property Owner Information)
Signature
Print or Type Name
--,&-�/ E cc 09 &�-e/.�'
Telephone Number
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS✓BOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to C,ffjis
(NaMe of Property Owner)
property located at 3�?- 2 wm-
(Lot, Block, Road, etc.)
on S° , in l or r 7 , N.C.
(Waterbody) own and/or County)
Applicant's phone #: I o .3(o-7 oz1S1 Mailing Address: 9 Z #", C "
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
-TD I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature Date
(Riparian Property Owner Information)
Signature
9U
Print or Type Name
Telephone Number
Date