74625D - McLendon

CAMA / - DREDGE & FILL NO. 74625 A B C
GENERAL PERMIT Previous permit #
X� ew 'Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commis ion in an area of environmental concern pursuant to 15A NCAC L07(� V
%% p����� El Rules attached.
Applicant Name ✓D �U i !^ G v'u"411�roject Location: County I-N�
Address 7-05- d IN (�dt�t�G�l N 6-Ove
City- rn u. I l- J State )(fCi zip 2751
Phone # ( _ d / E-Mail _
Authorized Agent wZ141
Affected Cw EW NePTA OPTS
AEC(s): ❑ OEA HHF IH ❑ USA ❑ N/A
PWS:
ORW: yes no` PNA yes
Street Address/ State Road/ Lot #(s)
?g rV . 4-k a(zk
Subdivision
City ZIP
Phone # Ri er Basin
Adj. Wtr. Body u^'` �� a an /unkn)
Closest Maj. Wtr. Body 4 / / 7
i
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Name
Signature ** Please read compliance state�en) on back of permit
App ication Fee(s) Check #
7�� " J ku
Permit Officer's Printed Name
nat re
j+o,Z� -15 2, Zs. Zo
Issuing Date Expiration Date

AGENT AUTHOREATNON FOR CAMA PERPBT APEWCATION
Name of Property Owner Requesting Permit:AoL(omb I M CLe✓1dw
Mailing Address: 2D h- OLd p►'�ly e-
C�,�
Phone Number: l �l - Sm - 0
Email Address: &V-C) OU Cowl 6(,a Mac . CUK1
I certify that I have authorized fY r.
Agent I Con#actor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: a bA < h ea,4
at m roe located at l(i� `hn GI e►�So-tom, B��d , I C
y property �—IC
in PerICA Cy' Co County.
l furthermore certify that l 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
Proper"'y Owner Information:
i
1gna
(' r� �iL� i c�ea� fO c L e Vid 0f.1
Print or Type Name
OV) n.e✓5
Title
- o l
Date
This certification is valid through I !
G

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tor,aL H,).Lfdryt 1, -Lep6(0,1 s
Name of Property Owner
property located at 30 �C) Avl 6LV�.) (O EL C3E cl }�
on
(Waterbody)
(Address, Lot, Block, Road, etc.) J
in 1 D DSa ILaL�� �P✓tLc� ✓' cO, N.C.
k (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locti
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)
�cpw�- buLYVva�
--- 1. 5-� ' --i
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.)
6I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signat
(aZ, �OL60M Jeri M-levidan
Print or Type �lnVame
�1�Dlc� =1�an�
Mailing Addre/s
Telephone Number%email address
Date
(Adjacent operty r 1)Ifor tion
SizuaWre
f * _� f
Print or Type Name
) !X) AT AJ rXg-"S &,4)
Mailing Address
I 'a tixo?�
Cit l tatelZip
Telephone N mberl email address
Dat
*Valid for one calendar year after signature"
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER
R OWNE I__ STATEMENT
I hereby certify that I own property adjacent to&01 [ D�cpM 9 �Jeah Iv���n �� s
(Name of Property Owner)
property located at Q(o �od(n W er5M B,J,• 2 W_ P!5 L &�Ck , nC
(Address, Lot, Block, Road, etc.)
on in TO `C P✓1 r Co . 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 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)
Q►r b(AL, hcAJ,
WAIVER SECTION
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.)
I do wish to waive the 15' setback requirement.
PWI do not wish to waive the 15' setback requirement.
(Properly Owner Inform tion)
h� C
Sign re
c rM (tengon
Print r T11
pe111ame
Mailing ,19.
`/ G l
City/St te/Zip
• L) I ILI l6rdebtaolkb .cow,
Telephone Numb r/email address
Date
►n)
Telephone Number/email address
K" 30 20/9
Date
(Revised Aug. 2014)
*Valid for one calendar year after signature*

Date Received
Date Deposited
Check From Name
Name of Permif Holder
Vendor
Check Number
Check
amount
P—it Numb-- Comments
Receipt or Refund/Reallocafed
Cokennl
Colutnn3
Co/umn3
Co/umM
Co/umnfi
Co/wrar8
C0/umn7
fbkpnnO
Column9
1028=19
B 3 J Construction of NC LLC
Madan & Michael Brazil
BBBT
2104
600.00
GP N7472BD
Tmac rot. 9200
1028=19
JL Morris FnWpriam
William PopWJeff and Noanie Monk
South State Bank
1353
200.00
GP M74623D
JD MIL 8539
1028/2019
Lighthouse Marine Construction Inc.
carol Holcomb R Jean McLendon
Coastal Bank and Trust
2904
400.00
GP k74525D
JD mt $542
SaltwaterHOA
M