74673D - Gonzales

-CAMA / DREDGE & FILL No. 74673 A B C D)
GENERAL PERMIT Previous permit #
New'
❑Modification DComplete Reissue ❑Partial Reissue 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 15A NCAC / j 101?b0
❑ Rules attached.
Applicant Name A f E 6002 11 _ Project Location: County NDE &
Address 310 LOaD tnwc
city WILhAW(,,TON State NL ZIP a r�
Phone # ( j) "j-13 '1418 E-Mail N/A
Authorized Agent �A
Affected ❑ CW XEW JK PTA ❑ ES ❑ PTS
AEC(s): L1 OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes /(515Z PNA yes / n�
Bulkhead/ Riprap 14
avg distance ;
max distance
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other Qw: 36 OL
Street Address/ State Road/ Lot #(s) 1 s 3 Al k1N50►.) Q.b
Subdivision f LA
City S.>RF C111 ZIP 2% 145
Phone # [phone] River Basin W 14"K OA1C
Adj. Wtr. Bold CPI nat unkn
Closest Maj. Wtr. Body Ax — fop5qll ,0 t,
A Ill
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Atent or Applicant Printed Name
ure ** Please read compliance statement on back of permit*
)20a ZO;1/83
Application Fee(s) Check #
PermkOfficer's Printed Name
Signa Ore
`� -(t- I I
Issuing Date Expiration Date

aws,.,....va..W=., ,o- �,.,.. wwo-.wMw.+wM•,.r rl� wfWfww►+.s, �b ,'3
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DMSM OF COASTAL MANAGEMENT
"CENT # ARIAN PROPERTY OWNER NOPFICATION/WAISiER FORM
AaofAWW. Ada
tw osws, SVW or , CIO &
I hereby t arm propariy 3*" ib #4 06" pro;*4. The iwm&w
has dn*ftd to m as n on ft dra the developa**
I b ve no objections to this proposal. I have obit om ro this proposal.
�� �o!{fcsnrnm��� yovm+�rr,�yr�.ar, or��.merrr�Jm
r � � +�lracypt of his �ttca„ �xrwpaa�,tr�r � bow to r� Cat�rl tktw art,
baftlidsoad......,,,,..,.,,.�,.�,...,.......,�.,..a�,:
WAMER SECTION
i ixWanytand ttW a pi4r; dock, m0ring PAVS. breakwaW, b00009.1ft, 0f9MlnnVWb669
alb s r**rium d rtca of 1S' tarn my area of riparian access t WaN%l byma (If you
10
�1*0 the sobacK Yw 1tat *W 3hstiapiroptWpe blank +)
`'i t Anti �►e it�r^� se4�tmr�.
I do net wlsh 1**ft# a 900budc tegWmment
(Pro" C>ssr w lfftmstim)
SFgnadrs�a ��
t
Fishtsr` �^t,�s
UD9-0
. 34-t
70*h"+m .._�..�...
4
4lnftmsatkm)
Prd ornY. Abm
11 3 ioIit 6 -
�T41 2Pj9 RECEJIVED
6l?B�iQi2
:.JINN 0'7?919.
DCM WILMINGTON, NC

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTI1FICATIONIWAIVER FORM
Name of Property Owner: JOse` `-� � , �{'��--
Address of Property: \ S -:� A Tlpk of Sin+ ► -Z Aq
(Lot or Street #, Street or Road, City h County)
Agent's Name #: Mailing Address:
Agent's phone #:
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are p 'ng. A description or drawing, with dimensions, must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you haw objections to what Is being proposed, you must notify the Division of Coastal Management (DCN) in
writing wftiWn 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext,
*711nington, NC, 28405-W. DCM representatives can also be contacted at [phone]. 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, 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.
1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
�W,o 60 4-g--
Print or type Name
3 1110 U�D L 0 M
Mailing Address
W 1 QM( A(ro
CitylState/Zip
82-� 3(-t q
Telephone Number
S Lt I 2 v( of
Date
(Adjacent Property Owner Information)
Signature `
Print or pe Name
� S� At Ic t',) E c�),o
Malting Address
Sb �-F C(t� C
City/State2lp
--�3(.�0�,, 3t�z
Telephone Number
S — �v RECEIVED
Date
Revised 6/18/2012 J U N 0 7 2019
DCM WILMINGTON, NC

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(ZF CAr4 c- RECEIVED
j DCM WILMINGTON, NC
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4

Date Recelved
Dare Deposited
Check From Name
Name of PemNt Holder
Vendor
Check Numbw
Cnac><
amount
Pe It Numb —Comments
Race/ for Rsfund/Readocated
Column!
ColumnP
Column3
Column!
Column5
Col-6
Column7
CdumnB
Column9
17
P
e 4