74628D - Rain

-CAMA / DREDGE & FILL NO. 74628 A B COP
GENERAL PERMIT Previous permit #
.�7, New El 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 Commission in an area of environmental concern pursuant to I SA NCAC
'" pp � El Rules attached.
Applicant Name VA l 1 � YV - 4 (LC'�C"z- r-r 1 I , Project Location: County
Address VA- I LA �Z 1g-O'PrD . IE
City V1 N)E'; 4yp-gs l State Nc• ZIP 7r A -
Phone # 01 fI) r27FS - 11% _Mail
Authorized Agent 1-
Affected ❑ Cw SEW A ❑ ES El
AEC(s): ❑ OEA ❑ HHF IH ❑ URA ❑ N/A
❑ PWS:
ORW: yes no PNA yes
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) y 10
Floating Platform(s)
Groin
Bulkhead/ RlRrap length_
avg distantW offshore
max distance`offshon
Basin, channel
cubic yards
Boat ramp
r�
Boathou oatlift X ' Z
Beach Bulld ng
Other
Shoreline Length r
SAV: not sure yes 0
Moratorium: n/a yes
Photos: yes
Waiver Attached:
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
or
G ('PEE -
SigrIature Please read compliance statement on back of permit **
Application Fee(s) Check #
Street Address/ State Road/ Lot #(s)
i le-,
Subdivision
City t9rSp I L- ZIP r�� >
Phone # ( 'r---- River Basin �/L • C�
Adj. Wtr. Body a.,04 O� r/ NO/man /unkn
C)
Closest Maj. Wtr. Body T�Spu- 0 (-�A-t
PJ
❑ See note on back regarding River Basin rules.
)71 �
erm Officer's Printed Name
Si tur
i2 • Iz' lg
Issuing Date Expiration Date

i
.ifA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Bevedy Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date
Name of Property Owncr Applying for Permit:
I ;�
Val = I I. Gi t r) TV" '- .t"� i 'C�... ..t. 4 t._ i 1 1
'Flailing Address:
j ' 7 A
I certify that I have authorized (agent) i"r'ci i r%�'ii N i�r'/ to act on my
behalf, for the purpose of applying for and obtaining all CANiA Permits necessary to
install or construct (activit}") t_ F ti j i
at (my property located at) L
This certification is valid thru (date)
Property, Owner Signature
io-31 -aa
j
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccowalmanagement.net
An Equal Oppurtun ty A!iimralsve Action Employer — 50'.. Recycled t 0% Pow Cmsumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIF.R/NOORTN(: PII,ING.S/ROATLIFT/ROATHOIIIVE)
I hereby certify that I own property adjacent to C, R a, i fit is
(Name of Property Owner)
property located at
� a - v'
(Lot, B ock, Road, etc.)
on a 6 w, , in C =A , N.C.
(Waterbody) k (Town and/or County)
Applicant's phone #:I,% —Jr — �72& Mailing Address: Ckr lat 17LON
/lb-8 o Q'.
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
(. V/I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be_flled in by individual proposing development)
See ctf'Ae�
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
/�- &� i 4k
Mailing Address
City/State/Zip
2%-J-a�^�77�
T ele hone Nu er 4,
Signature Date
Signature
(" kt�,, r /,s Ca,--) t-o 1rI,,,,
Print or Type Name
Telephone Number
<< 6�
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERINOORLNG PILINGS/BOATLIFT/80A MOUSE)
I herebc certify that I own property adjacent to
(Name bf Property Owner))
propem- located at
(Lot. Block, (load, etc.)
on
(Waterbodv )
Applicant's phone #:
q19 3(ol 2ti
N.C.
(Toss n and/or Counh )
Mailing :Address:
He has described to me. as shown below•, the development he is proposing at that location. and. I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift boathouse
must be set back a minimum distance of fifteen feet (l 5') 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 not wish to waive
(1f(� I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by indii idual proposing development)
(Information for Property Owner Applying
for Permit)
Dl f'Dla2 Gf • --
Mailing Address
/� AV,)5P^,e 0 A& .28q`(3
City/State/Zi
f 10 367 621-5-7
'Felephone Number
(Riparian Property Owner Information)
C, b
i1� Signature
Print or Type Nance
Telephone Number
N l L. -� L It
siplawre Date Date

YK
30�

Dot. R—I—d
Date Decmltd
Ch-k From
Name of PwmR Hddar
Nmd-
CMck Number
rratt/It
Permit Numbe IC--ts
Recd t w RdumUReaOoc W
cof—i
Cdumn2
Cdumn3
Cok-4
Cokmm5
CdumM
Co111unn7
CdumM
Cdumn9
I
12/17/2019
Land to Sea Construction, LLC
John D. Fountain, Jr. _
Allied Marine Contractors LLC
Michael & Pam Kerstiny
First Citizens Bank
134
$ 200.00
GP #74794D
GP 974813D
GP #74628D
JD rct. 9445
Tmac rct. 9094
JD tot. 8546
PA rct. 8521
12/172019
same
Safe Federal Credit Union
126
$ 200.00
12/172019
William & Rebecca Rain
First Citizens Bank
7991
$ 200.00
12/172019
F and S Marine Contactors Inc.
Adam Derbyshire
PNC Bank
8227
400.00
_ _
GP #74295D