74601D - Blizzard

CAMA / DREDGE & FILL NO. 74601 A_ B C CD) PERMIT Previous permit# - I-?l ->
'LlNew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 3 - I -1q
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 n:2 4J • 12
.;��`%) ❑ Rules attached.
Applicant Name 75�f �� D N 1 bQ ' � t 77 A P r Project Location: County f,
Address 1,� N ��' I1i1 (��7 �� Street Address/ State Road/ Lot#(s)
City (Ew'fU 1 LC State NC, ZIP
Phone # (�0 b- �( E-Mail
Authorized Agent th
Affected ❑ Cw Ow Z PTA ❑ ES ❑ PTS
AEC(s): El OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
PWS:
ORW: yes /,'no PNA yes _ no.,
Subdivision
City'x) F ZIPS"6/,4
Phone # River Basin w �, � ( U�. 1L
Adj. Wtr. Body I n P I L SL) L) o n na a /unkn)
Closest Maj. Wtr. Body T U(:�A l L SoOic)
Type of Project/ Activity L/V� 5�
Pier (dock) length
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Agent or Applicant Printed Name
6 -k - ZJ" ".,p 0
Signature ** PI ead compdance statement on back of permit
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Application Fee(s) Check #
P itofficer's Printed Name
Si *tu G
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
certify that I own property adjacent to __ L.e- 161-/ Z Z��/J ✓/Z s
(Name of roe Owner)
r located at `f- S �� C %� <<, / it ;Vr
(Address, Lot, Block, Road, etc.)
in - S td.--r/- C , N.C.
(Waterbody) (Cityfrown�r 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 have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
0�
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I i I �' U
VER UCTION j
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin mu§t 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) (Adjacent Property Owner Information)
Signature
Print or Type Na e
�"�� fly- ro3
Mailr Address ) j
crty�sr t� 9 - 9 /D - Z 0 - 0 3 Sq
Telephone Number
C1- z — 4
Date
Sig lure
!VyY n,4,J A •
Prin or T e. N e
t 1 _ cc.� r+ U C
g Address
.
City at r'p � 1 .7 - 7 0 1 3 6
Telephone Number
tola,;LI19
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMEN i
f.-
IF
II hereby certify that I own property adjacent to D >� �Z-�zZ `T� 's
(Name of Property Owner)
property located L%
on
(Waterbody)
(Add ess, Lot,fock, oadte c.)
in U/ �— C r , N.C.
(CitylTow and/or County)
The appli ant has described to me, as shown below, the development proposed at the above location.
objection to this proposal.
I have no ob�ec p p
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
F15'
I understand t atminimum d' cc . you
K* TJ
mooring pilings, bre
my area of riparian
oathous�e, or groin must be se back a
finless wai d by me. (If you-wiS-Vto waive
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Pro erty Owner Information)
46
Signature ature
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Print or Type Name Print Ty e Name1 `
114 � N IVCl� tf'9o3 W j\
Mail*ri Address Mai g dr �( ,
°� �� lac �- G `1
City/State)Zip C.
at /Zi
8"3 �t WI
Telephone Number Telephone Number
7102=?d o �K (d- 1c�-1�
Date Date
(Revised 611812012)

X,CAMA / DREDGE & FILL M 71789 A B C
GENERAL PERMIT Previous permit#
ANew Modification Complete Reissue Partial Reissue Date previous penult 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
I Rules attached.
Applicant Name��� (�2 _ Project Location: County �[�1 Rules
at
Address -- N • �i `� " l� 1. _ Street Address/ State Road/ Loott #(s)_
City �.,, N til��j� 1 L1.0• stag NC, ZIP 1?. v (A C l ---
Phone # _)Zto-'035'l E_Mall �i Z71t4 GUfwu Subdivision s
Authorized Agent _AI� eC - f—r • -tda,,City_ tJ / _ ZIP
❑ CW I SEW ❑PTA
Affected NPS OPTS Phone # ( �}� River Basin
OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A n un
AEC(s): PWS Adj. Wtr.
ORW Yes / �o PNA ves f o'� Closest Mal. Wtr. Body - -- �—
Type of Project/ Activity
Pier (dock
Fixed Pla
Floating
Finger pi
Groin le
nu
u ea
ayg
max
Basin, -chi
cubi
Boat ram
Boathous
Beach But
Other -_,
Shoreline
SAV:
Moratonu
Photos:
Waiver At
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notsure Yes
n/a yes
yes
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A building permit may be required by: �L
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
CJ See note on back regarding River Basin rules.
E rM
e or Appliant Printed a PE Ocer's Punted Name
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Signature *• read lance statement on back of Si na re
pl g /
Application Fee(s) Check #t Issuing Date Expiration Date

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MODIFIED PROPOSAL
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Date Received
Date DqP slfed I Check From Name),i
Name of P~ Holder
VerMor
II Check Number
-
amount
Permit Numb —Comments
Receipt or Refund/Reallocated
Columnl
Columnl 1 Column3
ColumM
Columns
Column6
Column?
Column8
Co/umn9
1
Onon R and Anne e L 81—d
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27
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