74252d - Keever

CAMA /,'l�' DREDGE & FILL
GENERAL PERMIT
)(New -:]Modification ❑Complete Reissue El Partial Reissue
No. 74252
A B C DO
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 15A NCAC O 7 100
❑ Rules attached.
Applicant Name JAM£5 KF1r_VF cL
Address &>x 14
City 11 I (IA P-1 AJ-r State ZIP 272(s I
Phone # (fit,) 44Z- 3150 E-Mail T M Q cojort;alllc . c on.
Project Location: County BRLA-A1s W I c K
Street Address/ State Road/ Lot #(s)
12&
LLAMCER-r01A/ 5TC3IEFT
Subdivision 41A
Authorized Agent I F n & Z i dA/IFI;n 9E L*k s City HoL. o>_ N 13 i"Ac N ZIP ;z r 4 & Z
Affected XCW XEW )(PTA VS )<PTS Phone # (9 (o ) 443 - 4 8 9 8 River Basin L" y m v_
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body CA AIA L_ (nat ma /unkn
❑ PWS: )
ORW: yes no PNA yes /,` no
Closest Maj. Wtr. Body A l W
Type of Project/ Activity f —C PL Ac E FLAL.K-NEAP I J'/ 'EE�X I 5-r#Al6 /II.I c, n/ M r-,1T
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A building permit may be required by: H D L See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions 0 rJ N. 11 p Q J 2 0 Q Ap/p ALL o f EI r i?,-
LOCAL_ , S ATr_ .. dAto Fr—DCRAt_ I ECaLlt AT►oA/s APPLY.
Y,,"�' I( Y 0 t 1 r� 5
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
6,00 -* 1353
Application Fee(s) Check #
1 YLf:K I"Lc 6J A1RE
Permit Officer's Printed Name
Signature ell
5/10 /z619 9 /l o /2 0 19
Issuin Date Expiratio Date

Name of Property Owner Requesting Permit:
Mailing Address: Vo !20K y g
HT&H dsN-T-
Phone Number: S3(e -- (f LI Z - 31 SO
Email Address: ,-M 0 -A1 1-Lc C-6-A
I certify that I have authorized t i m
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _ A) C ,-J acy-jc-
q n J :P W A 7i N G- Qrl
at my property located at i Z1,Q L u /h 3 E Q TO /`� _. -5 � 4� p� � L �'"� ►3Et C l t
in � �t d NS w 2l,-- County.
i furthermore certify that 1 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:
i
Signature
�arn e-5 kec.ucl-
Print or Type Name
ejW &�
Title
l �C? 1 I
Date
This certification is valid through 1 /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to \ „ti1 %,=V s
.{Name of Property Owner)
property located at _
(Address, Lot, Block, Road, etc.)
on CLnain - N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
t�\� �-�7 1 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.)
.t;A-,&, I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
r
Print or Type Name
Kf L t7 k-,
Mailing Address h
I nr)It , CJL ` q,
City Atte/zk _
Telephone Number/email address
VI N
Date
(Adjacent Property Owner Information)
114
7?1 Z
l phone Nu ber, / email address
7l; .�'/ Y
Date*
'Valid for one calendar year after signature'
(Revised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT K, :QUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, Cit. & ,ounty)
Agent's Name #: 1 �,� �,I�►'L GG Mailing Address: I,qb� 44i44.4 K-J1
Agent's phone #: 9 16'�-�`i'3
I hereby certify that I own property adjacent to the above re' !renced property. The individual
applying for this permit has described to me as shown on the :' iched drawing the development
the/aar p posing. A description or drawin% with dimension t . �t be provided with this letter.
I have no objections to this proposal. I hax - ,hjections to this proposal.
If y 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; n_q 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, br rater, boathouse, or lift must
6e set back a minimum distance of 15' from my area of riparno,I L ccess unless waived by me. (If
you wish to waive the setback, you must initial the appropria'.e t lank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requiren'Wnt.
(Property Owner Information) ;gnature
par' . 3rope 7nerInformation)
Si nature
" S � 1 6J-�,Wlj
L
rint or Type Name
ed
a� Address
siwi(Ae- 0?
City/S a e/Z'
16- U 3— 09
Telephone Number / Email Address
Print or Type laame
Mailing Addrw.-s
,4� er,:
CityiStat: —
Telephone N_ nber/Email Address
`f/I I I i � 1i-//-"�
Datel Date
(Revised Aug. 2014)

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Date Received
Dete Depo.fd Check From (Name)
Name of Permit Holder
Vendor
Check Number
Check
unt
Permit Number/Comments
Receipt or Relund/Reallocated
Columnl
Columns
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C.1-4
Co1umn5
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Keever
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