68060D - Fisher

XCAMA / . DREDGE & FILL
GENERAL PERMIT
XNew _ Modification ❑Complete Reissue ❑Partial Reissue
A
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC d 7 N . / 2 C7 0
❑ Rules attached.
Applicant Name IrI E ri Z514E-FL
Address I & 0 $ j9}tET '5T
City W ILMI,W_4-r nl State C ZIP 21*01
B C
Project Location: Countyy-a, /Sh/1 c x
Street Address/ State Road/ Lot #(s) &
O Al F. O E -rA 1r aT
Phone # (910) IG40 -17Z 8 E-Mail CkishcrfacoascA Subdivision
,co
Authorized Agent K Ja TED N Et City 0CZA v SSGE ��± r-JA ZIP ;2 946 9
Affected )`CW XEW ;i PTA ❑ ES ❑ PTS Phone # (410) s.74 - 8715 River Basin L NMor-r-
AEC(s): ❑ OEA • �] HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body CAOVA L (nat �)
❑PWS: AitWW
Agent or Applicant Printed Name
Signature * Please read compliance statement on back of permit`
Application Fee(s) Check #
1 `/Li;R M c,GLAs e
PermitOfficer's Printed Namet
Signature
t/`71Z019 q b �zal'9
Issuing Date Expiration Date

On WPA, Jan 23, ?0 19 at 5.29 PM C
Name of Property Owner Requesting Permit:
Maikng Address: -A All epA� ��4-.-
lk)
Phone Number: 5,573?
Erna,' Address,,,
I certify that I have authorized
Agwit r Cordradw
to w-t on behalf, for the purpose of applying for and obtaining alt CAMA permits
nf-c-essary for tl* failowinq proposed developmei-L
"i-, awe. Cow
Y iocal at p eft i0cated at
in *C;Lccjlinty.
I furihemvre certify that I 8M SugloriZed to grant, and do in tact
Division O(Coastal Management staff. the I -ocal t"-Ie!rnI 0,11061 cer and their agents to eater
on the atom men tione d lands in connection with evalu.a tin g Mbrmadon rela
pL-rait oppkation.
Prop" Owner L-Iforma i
P!!1W �x Tvpo Narr-t
. . . . . . . . . . . . . .
f
777`7

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner: c�,d h h E:i -,hP r-
Address of Property: ( a M nnrce- 6• ICCOE) f�faCJI r?)Yun5y-A(-1C
(Lot or
Street #, Street or Road, City & ��ounty)
Agent's Name #: K l� sal e r n . Mailing Address: [9-6 7 Kill
Agent's phone #: q(b-yy3- 4Rgk �i� �1�� kc VFW o 2
hereby certify that I own property adjacent to the above r( ;er raced property. The individual
applying for this permit has described to me as shown on the at;- Ched drawing the development
they are proposing. A description or drawing, with dimensions, mw.,st be provided with this letter.
I� I have no objections to this proposal. I have c bjections to this proposal.
(L If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http://www.nccoastaimana_qement.netlweb/cm/staff-list:Mg or by calling 1-888-4RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 Lank below.)
lr,j a j� I do wish to waive the 15' setback requirement.
�tf E' I do not wish to waive the 15' setback require nt.
(Property Owner Information)
Signature
i —t d 0,.- tms
Print or Type Name
6 ri if i rbu rd
Mailing Address J
SUDVIW Kr
City/State p
q its-- Q q 3- `f s t -S
Telephone Number/Email Address
21W Ig
Date
(Riparian F opert Owner Information)
199�) e)A AlPIS/NGx,6 A41n It y iR 1/S?
uS(�
SIgrrat ure
,&6&�2 p T
Print or Type Frame
2 _ ,LcG 4W10
Mailing Address
.W j0/U L"- s ,e 2-0707
City/State/Zip 1/
Telephone Nu. nber Email Address
,te
(Revised Aug. 2014)

■ 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:
A- bN2,
5 so t��end Oa-Kj (bj--
1 t Iff/I 4*1, q to
9590 9402 4454 8248 7488 93
2. Article Number (Transfer from service lahal)
18 068D DDDD 7025 4615
►iq
X
!�Pk Addressee
Date of Delivery
D. Is detivefyaddress different f m 1? O Yes
If YES, enter delivery address below: 1<110
3. Service Type
O Adult Signature
❑ Adult Signature Restricted Delivery
O Certified Mail(D
❑ Certified Mail Restricted Delivery
❑ Collect on Delivery
❑ Collect on Delivery Restricted Delivery
❑ Insured Mail
11 InSUred Mail Restricted Delivery
❑ Priority Mail Express®
❑ Registered MailTM
❑ Registered Mail Restricted
Delivery
❑ Return Receipt for
Merchandise
❑ Signature ConfirmationTl
❑ Signature Confirmation
Restricted Delivery
Ps Form 3811, July 2015 P3N 7530-02-000-M Domestic Return Receipt

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
J.
I hereby cegify that I own property adjacent to (1rknrli' s
-- �ame of Property Owner)
property located at Ar, An& S�-
,, (Address, Lot, Block, Ro d, etc)
on aQ0 , in (j'_ffi(1 ,:,j�_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"G( 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)
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.)
kE6(' _ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Ad' cent Property Owner Information)
Signat rYle` Jigturtur �
eC1 /"
Print or T peName Print r Type Name
ja07 Li/6,a /�c�' lVluhrue S�-
Ma ing Address Mailing Address
k
City/ at ip C'iryl9fTielZip
Ito-�l�3-�d-9� q lq-�S•�- 3�1 �"1
Telephone Number / email address Telephone Number / email address
Date Date*
(Revised Aug. 2014)
-Valid for one calendar year after signature`

FtO,4-TT
t\A L-7
C, T
Aj