74553D - Evans

r"CAMA / ❑ DREDGE & FILL
GENERAL PERMIT
El New ,Modification ❑Complete Reissue ❑Partial Reissue
No. 74553 A B C
Previous permit #
Date previous permit 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 I SA NCAC 01 H , 1 2 0 0
❑ Rules attached.
Applicant Name TA ME5 VA,-Jl S Project Location: County AICV4 OAni oyF-,P-
Address11 --'' r% 14 An EAR/ Dy-%y � Street Address/ State Road/ Lot #(s)
CityW JL.M1Ak TOn/ State/y C ZIP -2-Y4o 5 SAN1r__
Phone # (ql0),5.ZD- 2 3 (o8E-Mail; d4V41SSr2&°' atr,oA.ror-Subdivision ARTCAAI 1 \1 i Hr- Sok-.ND
Authorized Agent L l M el Y RTN City ZIP
Affected ❑ CW -54EW XI PTA ❑ ES ❑ PTS Ac-IT j4 i Phone # (q 10 ) 2 31- 8 5 14 River Basin WO ITC CIA V
❑ OEA ElHHF ❑ IH ❑ UBA El N/A AEC(s): Adj. Wtr. Body pACi C S Cit- r- V_V� na /man /unkn)
- PWS:
ORW: yes / PNA yes / no Closest Maj. Wtr. Body M IDDLr Sov.N o
Type of Project/ Activity COA1SiRL,%,C-r /v Eve & c>A-r L►F-I- AN•o 17-EL-0C/A'1E
Bulkhead/ R1 p I:fnf
avg distan offshore
max distance shore
Basin, channel
cubic yards
Boat ramp
Boathouse/ oatli (3 1<
Shoreline Length:= 322 1
SAV: not sure yes 0
Moratorium: i✓ yes no
Photos: yes
TR r
Waiver Attached. yes 0°
AI ,4pwo-( P1L
A building permit may be required by: /,r ti I-IA1 t4OV r- Tz- COLA k/T j ❑ See note on back regarding River Qj&i r llps
( Note Local Planning jurisdiction) 71 o ez.._r E /
Notes/ Special Conditions AL L- Cvn/y tT I oNS nr- 07 H • 12 0.0 4 A ► c: r u Fr rw R A C-.
STAit; 1; 8. LOCAL 12r C,0LATtbNS APPLY, DoCtLt,J6 E. CILiT%4 st-IAt_L- NUT
AVJACr-A✓T RtPAR 5FT13.AcKJ. -
Agent or Applicant Printed l4ame Permit Officer's Printed e
Signature ** Pleas read compliance statement on back of permit Signature
It2oO = 9-2S i z f3o/ j I./zo
Application Fee(s) Check # Issuing Date Expiration Date

11 /18/2019
Agent Authorization Form - [e-mail] - Gmail
Name of Property Owner Requesting Permit:
Mailing Address: `�/ / ✓�✓ r r�,.�� U�,
i
Phone Number: 2d J-;(s
Email Address: �z VAY15 sk`�-�
certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1
at my property located at
in /U e`j /14."e' e/County.
1 furthermore certify that l am authorized to grant, and do in fact grant permission
Division of Coastal Management staff, the Local Permit Officer and their agents to ento
on the aforementioned lands in connection with evaluating information related to th
permit application.
Property
Signature
a , h11\
Print or Type Name
Date
Title
This certification is valid through
RECEIVED
DEC 1 3 r _'r;!'
DCM WILMINGTON, NC
https://mail.google.com/mail/u/0/?tab=wm&ogbWsearch/ca/FMfcgxwBVWJTPgwFnWtgWDmrKDNdxmJB?projector-1 &messagePart1d=0.1 1/1

Lrco4,:o �
F CZ
h�
oJ� 15�f^`S

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to E v is
(Name of Property Owner)
property located at - --e c
Address, Lot, Block, Road, etc.)
on 1tG C le in c ti0 rf c/ N.C.
(Waterbody) (City/Town andlor 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 fill in description below or attach a site drawing)
e e dr e:, L-,-2 %Y S
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 req
(Property Owner Information)
Sign1ofiff_ / \
Print or zType/ Name"/ C/
Mailing Address
City/5tate/Zip
Telephone Number
/, //Q /,n
Date
Telephone Number
) -s -
Date
Information)
a
W N
>
w
U
W w
T CD
(R9VjWd.&1&2012)
U
z
z
0
z
U

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1 ! -1 C v a w is
(Name of Property Owner)
property located at �i f I Ir 01 -J i t
(Address, Lot, Block, Road, etc.)
on r-)a in lU P cJ g a to n P- el 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.
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)
r
see "c,C.),.,s
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
minimum distance of 16 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)
C )--) r�
Si,
Print or Type Name
/ J
Mailing Address
Cl4
y/5tatamp
Telephone Number
1i /l Ski r
Date
e,CS
Print or Type Na
Wing Address
�I 1J4,,�rv�
Telephone Number
//- /9 - /%
Date
i�� uki)N
w
W
w
cc
0Reviod'$h$/2t'M2J
U
0