74391D - Nealeans

CAMA / _ DREDGE & FILL No. 74391 A B
GENERAL PERMIT Previous permit #
Clew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality `` v
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC �1 Z
❑ Rules attadled.
Applicant Name 2.. U i 2a: r 's Project Location: County 1( ^ s w. c )e-/�
Address �(� Q o lC Street Address/ State Road/ Lot #(s)
City �U �u� -�i State I C ZIP �.-���D vim,,, +^ S�
Phone # (`A W }� �� E-Mail Subdivision
Authorized Agent (.;We q
Affected ❑ Cw [XtW Ig PTA J"S
AEC(s): ❑PEA ❑ HHF ❑ IH ❑ UBA
❑ PWS:
ORW: yes / PNA yes 4no
Type of Project/ Activity /1`
Pier
Fixec
Float
Finge
Groh
Buller
Basin
Boat
Boatl
Beacl
Othe
Shore
SAV:
Mora
Photi
City o k'�e c. ' ZIP 'A&
❑PTS A►, -Phone # ( )� �lU (o 5)LJ River Basin
El N/A Adj. Wtr. Body .*1Ati le an /unkn)
Closest Maj. Wtc Body A i w v./
CV 1 41 n G1 4�c d l i
(Scale: All 7 S
.ng Platform(s)
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Waiv ,(�— r
A building permit may bV required by: o,,,,,,. �, 1 {o> I & F G k ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) l-
Notes/ Special Conditions (� �TO I
f o �OR.
a\/1",f-
(Agent
Si re ease read compliance statement on back of per
O ()
Applicatio ee(s) Check #
�0_ /-\� a.. �(- odi
PermkOffjter's rintedName
Signature
\131
Issuing Date 1 Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: D r-e—wMt:6�lJ& lk-1 J
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: %
at my property located at rlr,
in4&-�rCounty.
1 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
-)') ;VCQ WM
Print or Type Name
Title
11 1 13) I j
Date
This certification is valid through I l

I
)-Of
EZ)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 7)" Mc-xl' E -5 I
(Name of Property Owner)
property located at 13 L �� �,�� rJ 5T /VW
(Address, Lot, Block, Road, etc.)
on , in Poi-JiFnJ 3eAc4 N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
localieq
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)
WCA
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.)
1 do wish to waive the 15' setback requirement. SC
I do not wish to waive the 15' setback requirement.
(Proms r Inf mation) (Adjacent Property Owner Information) ✓✓I/
g Signature*
si _ d0aWs
Print Type Type Name Q Print or Type Name
,V- � -7 7/ A1`t IAA I Sbcrc�c,�.
Maili A dress.., M iling Address
�'� tt [JDI -4T jJL �-"j L(o Larr%crc^ . N . 0_ . 2-1 Sio
Cit State/Zip City/State2ip
(S0-'1Zti-dw—JVAA, al(r," 11q-ei-I 1-7 919-Y01-013o
Telephoner/email address Telephone Number/email address �rxrb4�®
/ 1 01 2c 17r, k q 1, : a►,a.,�Qrwb; s�+ . col.
Date Date
(Revised Aug. 2014)
"Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -DR&tj /kxt,�5 's
(Name of Property Owner)
property located at l3 L �f�!�/-�� � 5i /11 w
(Address, Lot, Block, Road, etc.)
on , in 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)
0
►° WO
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 ish to waive the setback, you must initial the appropriate blank below.)
a "
1 do wish to waive the 15' setback requirement. z(
I do not wish to waive the 15' setback requirement.
( ope Owner Information) (Adjacent Property Owner Information)
Sig `1 tre , j Signature
Printp5 Type Name Print or Type Name
Maili A 'dress-, Mailing Address
Cit State/Zip City/State/Zip
IqVI
Tele hon Number/email address Telephone Number/email address
p 0*7�-k �. l9 16, A� 9 9
Date Date*
(Revised Aug. 2014)
"Valid for one calendar year after signature*