74236D - Ingle

KCAMA /7 DREDGE & FILL
GENERAL PERMIT,
)(New :]Modification ❑Complete Reissue ❑Partial Reissue
No. 74236 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 0 0 L>
v ❑Rules attached.
Applicant Name_ / f�f lZ DOAv & ?-Z5F_oc,A Project Location: County 13Ruw/ Sw l c 1,
Address /0 $ tI LIjJTEiL N iu, Rv Street Address/ State Road/ Lot #(s) 'I
City C NAPE L 141" State flC ZIP 2751(o
Phone # (q1Q) &07- 351 l E-Mail
Authorized Agent R i cK W
Affected ❑ CW )(EW XPTA ❑ ES ❑ PTS
AEC(s): ❑ OEA D HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
ORW: yes / 6
PNA yes / n(�o
LALA a6wa► 9—c, STReET
M11
Subdivision N/A
City OG ZAtJ &5.Ac N ZIP 2?
Phone # (7004) 3(93 - 0(P & R River Basin Lu MOE.tt
Adj. Wtr. Body C^NAi- 1nat kn.)
Closest Maj. Wtr. Body
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or Ap icant Pr' ted Name
Signature •* Please read compliance statement on back of permit •*
12-00 .95478'
Application Fee(s) Check #
_rY .151 R. M c G U 1 R>•;
PermitOfficer's Printed Name
Signature
5ZIto' 2011 9 to>/,4a9
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: --ZN9 /E Ye ; r�J
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CA )MA permits
necessary for the following proposed development:
at my property located at �'b
in--� ('4/'.5 4-) ,C-- IC -County.
l 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:
Signature
Y ird o N
Print or Type Name
Title
1 I S— 1 f l
Date
This certification is valid through /0 / / � l/7 -

4
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�o �v ^� i s� � ! (.•a�,-cam �1 >�-�`� 3� ��' ,�
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-,,� (T V 07 -J� J-') (2 (,-' 611 JYJ �' �// � V It)
9�1,7(q �

DMSION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTiFICATIONIYUAIVER FORM
Name of Property owner ?�nS 1 E
Address of Property_ 7G L �� ••.� ZLc g Oz 0 A c %G
;r (Lot or Street #, Street a Road, City & Cou*)
AQent'a Name `, c 1C GJg�' ��,•, o cam) tang Address: 170? 04Y
Agent's phone # 70� .�G3-ol.�$ �213 N c._ ,,�6 g
I hereby certify that I own property adpoent to the above ruferenc ed property. The tndlwduai
applying for this permit has described to me as shown on the attached drawirp_the devetopinent
they are proposing. A deacrtotion of drirw. with ftwornaions. must be provided with this ktt0er.
I have no objections to this proposal. I have objectiow to this proposal.
H yoo bw. 08� jaettone so whet is ba4nN proposed, run awrat notMy en. Divlaiar or Co+sfii lfareaynrww (DCag in
wi tkfp wNW. 10 dqs of nica*t of Nis no*& ConaWondo ahouuk be neaisd bo 127 C&COM4 diva eBrt,
Mied"y[on, NC, 2844464Q XV npteanlstives can aisa be contw at (NO) 196-nl& No Happens is
—-midwed bNe amwe "no owwoon N ym bsny boss no4NJsd ft CW~ fta
WMYER SECTION
I understand that a pier, dock, moorirsg pMngs, breakwater, boathouse, UL or groin must be set
back a ff**num distance of 16 t erne of riparian unless waived by me. (tf you
Wien to 7wish
the eppropnete blw* bei w.)
aive the 15' setback requirement
_ I do not wish to waive the 16 setback requirement
(P Owner>�slomsation)
� t
Sigratxv�e
�rt /CirgO 31J
Pft Or Type Name
Joe kuti.�k.-
Cft)1
q1 1 ? - G 0 9 - .3S91
Telephone Nkmber
:2�-�di
Dart,
(Adjacent Owner HWmation)
Vc� rt J• C�oI _ iC.,-7tXOn
Print or Type Name
T.„d;a., T.-.0 1. 1vc 7h,97
Toy-3o,
Telephone Number
Bois
Revised 6Ma/7012

,:;:.I d0 not woh"to wgr,,a 00 tS w Wck t*r4"O n'*'4

Daro Received
Dale DePo3lted Chock From Name
Name o/Perm/f Holder
Vendor
Check Number
Checunkl
Permit Number/Commenfs
Receipt or Relund/Rea/located
Column?
Co1umn2 Col-3
IAMW
Col-4
Columns
Column6
Column7
Col-8
Column9
5 1 1
Docks and Manne ConcV on Inc. Veirdon 8 Rebecca In le
5176 200.00 GP #7d 36
'TMc rct 8200