74633D - McDonald

.. ECAMA / ❑ DREDGE & FILL NO. 74633 A B C e
WGENERAL PERMIT Previous permit#
)(qeT 'Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality tt� 1D
and the Coastal Resources Commjssion in an area of environmental concern pursuant to 15A NCAC t
PC
llles attached.
Applicant Name/y�//1G% Project Location: CountyTi�f�
Address
City �y �;
Phone �( q) J
Authorized Agent
ElCW
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A
Affected
Affecte ElOEA
` ❑ HHF ElIH ❑ UBA El N/A
❑ PWS:
ORW: yes / n�
PNA yes
Street Address/ State Road/ Lot #(s)
124- ir�i wc'6es 'il'�
Subdivision
City l (J�Sf�,C� ZIP
2•/
Phone # River Basin W
Adj. Wtr. Body /G.5 nat man unkn
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Closest Maj. Wtr. Body
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Agent o pplicant Printed Name
Sig�natu�re) ** Please read compliance statement on back of permit � � � /� ' � � , f
Application Fee(s) Check # Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
d tAk 4 / / 1
Name of Property Owner Requesting Permit: f
� � l� C-s'6 1/ "iG�/� s
r rty M �
Mailing Address:
Phone Number:
Email Address:
1yeaJ IVL aqg_yzvr
9/9- 9aa- yr�
I certify that I have authorized ,
Agent / Contractor
to act on my behalf, for the purpose of apply
necessary for the following proposed devek
at my property located at
in
County.
I furthermore certify that I am authorized
Division of Coastal Management staff, the
on the aforementioned lands in connectio
permit application.
Property Owner Information:
l/ Ignature
Print or Type Name
Title
r
Date
Dynamic
Benchmarking
PERFORMANCE MATTERS
q;AAC..& �-4a0?-yiz/
dynamicbenchmarking.com
RECEIVED
This certification is valid through L' / I / �U DCM WILMINGTON, NC
MAY 13 2019

CERTIFIED MAIL • RETURN RECEIPT RE UQ ESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
r. /`d Ar;A- 1,� -OL-L—/
� Name of Property �wne !"t 1
Address of Property: Id K lb
(Lot or Street
Agent's Name #:
Agent's phone #:
Ll X
Ave,
or Road, City & Cou )
Mailing Add ess: 30 Y N-ile A4 -�22?3yo�
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 proposing. 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 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. Correspondence should be mailed to 127 Cardinal Drive Ext,
Wilmington, NC, 28405-3845. 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.
I do not wish to waive the 15' setback requirement.
(Property ner Information) (Adjacent Property OwneF I formation)
"X,
Si ure J
t4sr:✓t- / /Signature
Print or Type Name Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
Mailing Address
Ir a l 1d ck- to C x�q L- co
City/Statezp
qlb--a45- 13Sh
Telephone Number
RECEIVED
DCM WILMINGTON, NC
Date 3 2019
Revised 6110612 1

ADJACENT RIPARIAN PROOPERTYOWNE
,I hereby certify that I own property adjacent to PAd'ytA0-,0
Ll / (Name
property located at / J 5 c-/Sy e'
/ (AddresE
/
on JW'5,n, l .5") , in
(Waterbody)
(City/Town and/or County)
14,.-le-5's
N.C.
The applicant has described to me, as shown below, the development proposed at the above location.
WI 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, 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.)
xI do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property O nfo ion) (Adj cent Prope Owner Inf rmation)
Si atige, Signatu> e
N (L'LJV�
Prin o ype Name e �c1 Prin�,or T e Name
Al i
Main ddre— MailingAd ress01 1-e Al-& ) ��
C7 City/State/Zp TKh �/�.2 `/7 ,�`� �
�i
Telephone c�mb�/f n Telephone Number
Date / 7 Date C F I V E Q
[)CM WILMINGTON, NC
(Revised 611812012) MAY 13
2
019

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Date Rece/ved
I Data Deposited
Check From Name
Nama or Permit Holder
Vendor
Chedt Number
amoum
Pemdt NumbenCommenb
Recsi f or Refun&R"Abcated
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