74385D - Gravett

KCAMA / ' DREDGE & FILL
GENERAL PERMIT
XNew ❑Modification El Complete Reissue [-]Partial Reissue
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_
No. 74385
A B C
Previous permit #
Date previous permit issued
07#- peo
❑ Rules attached.
�" ,,
Applicant Name �1%YIu r�
G/(f,(f(j'�'t
Project Location: County
Frww5 L
Address 446 Mhvn, Hp n l
\hl, SV
Street Address/ State Road/
Lot #(s) JOvyAZ
City 10IN4
StateNCi
ZIPA&G2
Phone # ( /v) 9JC A3al
avA1E_Mail ikQd-r-WO
fly+ mZaJ,b^jlc•wo,Subdivision
Authorized Agent 45 CMSTryrt'b/1
City —
ZIP —
❑ CW Ill EW
® PTA ❑ ES
❑ PTS
Phone #
River Basin L-L . tT
Affected
AEC(s): ❑ OEA ❑ HHF
❑ IH ❑ UBA
❑ N/A
Adj. Wtr. Body L60—aock
FO Ily Q,V'Pr 64P/man /unkn)
❑ PWS:
ORW: yes /,rnol PNA
yes / no
Closest Maj. Wtr. Body1/�
Type of Project/ Activity
✓0 0`
i? 7X
S tb
� S
,Ulf(
(Scale:
Pier with
Fixe
Float
Fing
Groff
Bulkl
Basic
Boat
Boat
Beat
Othe
Shor
SAV
Mor,
Phot
WaiN
n Platform(s)
■■■■■■■■■■■■�i■■■■■■i■■■■■i►�iw'�''
rwl��■■■■
length
number
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■I/�{_��Sr����■■■■■■■■■■■■■■■
max distance offshore_■■■■■■■■■■■■■■■■n�!■'■,.\'ram
.1l�I■■■■■
■■■■■■■■■■■■■■■■■;'tfM�!t�Ltd.�'391\�\
■■
I�
ii
In
i i■■■■
■■■■■■■■■■■■■■■■■■■■■■■■Y��kt�n■■■■
■■
cubic yards
ramp■■■■■■■■■■■■N
3:!1741"13Uo
711FA0MWII
I■7■
III
rwVT
MR!n■■
■■■■■
��■■�■a■��r■I
-i Bulldozing
■■
I■■■■■■■■1■■■■
■■■■■■M■■wRI■■■■■■■■■■■■i■■I■■■■■■■■■■■
■■■■■�[J��I
JC/11111111111LMii•r
SEE
I&-=K:'=KL4
■■■■
■�■NE
■■Ea■■■■■■■■■■■■■■■■■■■■
-\I
■■
notsure
yes
•
■■■■■fIL
a■■■■■■■■■■■■■■■■■■■■■■■■■r%■■■
•
■■■■■■li■■■■■■■■■■/,�■�I�I■■■�■■■■■■■■■ii■■
A building permit may be required by: 9rwlsw'e C 1~2%t ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions tyl,,,& S Q CAI +N S �,n 0 -714. 11 D D GE�1�J Igo OI OS � Q� O �
Alt �etrcpi
Agent or Applicant Printgd N me
Signature "Please read compliance statement on back of permit
wr �3 39
Application Fee(s) Check #
Permit Officer's Printed Name
a 4 i
Signature
Issuing Date xpi tion Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 2ZJ / ' �/�-�-U40 �2
Mailing Address: i y�p
��
! O.1
�� f
�nu-01
a
%e yzz
Phone Number:
Email Address: 1 LL( DCJ ��/,✓ fl/�✓� Z �f'%!�`G.
I certify that I have authorized H5 Construction LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
l��=ly �Ll�JGs
at my property located at
in (SjzLycwl CAC, County.
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
'�; —ItIll
Signature
Print or Type Name
Title
-I/C---tZ2�
Date
This certification is valid through / /

I hereby certify that I own property adjacent to (� tGtifal'l s) (9,N _'s
�Na'O,Property Owner)
property located at T 7���7'/�ir'tG Iry 6i/ili
(Address, Lot, ck, Road, e
on �( i1G�`DD�j 1--o (.y _, in /l1uawl �.�S�fG� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
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)
�0A i p r T
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.)
6z I do wish to waive the 15' setback requirement. (S:W
I do not wish to waive the 15' setback requirement.
(P:?=
Signatures
[c:►CWc14 /Z-.> zz'-3
Print or Type Name
Mailing Addre
City/State/Zip p/n— �lD� _ED
Telephone Number/ email addres
���20Y
Date
'Valid for one calendar year after signature"
(Adjacent Property
Owner IInnformation)
Signature*
Print or Type Name
Mailing Address wo
City/State2�ip ©C fL"f1A ,t d ZD vz-2—
Telephoneube�9 z. it dd
?
Date* ! //
/C!J LL!!✓✓(Reevised Aug. 2014)

RIPARIAN PR
TEMENT
I hereby certify that I own property adjacent to ( (9/Z/>0f>1'-t-- I
�ame-pf ro/ y Owner}� /� z�
property located at— /y/�l�,Y� '� "�"7 N i
(Address, Lot,134pck, Road, etc.
on �lJG/LL,�Jb /�' , in
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
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 to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. Y
I do not wish to waive the 15' setback requirement.
(Propert Owner Info na
SigtTatcrre�G,/���
Print or Type Name tl"' c I�
Mailing Addre,81 i�
City/State/Zip-� /���i/'
Telephone Number / email address
Date �f✓LLOi-t� 1'l � � �� � P/ �jlN�"
'Valid for one calendar year after signature'
(Adjacent Property Owner Information)
Sign 1/�J
Pn or Typ me
ula
M Addres ISot'101 ' /�� Z�-'4ZZ
City/State2ip�j�^
Telephone Number/email address
Date*
(Revised Aug. 2014)

Date Received
Date Deposited Check From Name
Name of Permit Holder
Vendor
Check Number
Check
—t
Permit Number/Comments
Receipt or Retund/Reall-aced
Co_lumnl
Column?
Co1umn3
Column)
Columns
Co/umn6
Column?
Column9
Column9
9r27t2Ol9 9 7Construction
LLC
RichardR-chard Gravatt
RB&T 2338 S 40000 GPk74385