74704D - Rabart

.. XCAMA / ❑ DREDGE & FILL NO. 74704 A B C
GENERAL PERMIT Previous permit#
(New El Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality y
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules jttached.
Applicant Name r�I S W i2
AddressS
City- , PIM f" ->rpP J- State_ ZIP7� 3
Phone #,��3) Sq -! ) E-Mail
Authorized Agent �'/'4 6 I P , i �__ �L-1 L.
Affected ❑ Cw A ❑ ES ElPTS
AEC(s): ❑ OEA ElHHF LI IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes ' O" ) PNA ye4I no
Type of Project/ Activity
Project Location: Countyi R Q-,',
Street Address/ State R d/ Lot #(s)
1/ d
Subdivision
City ZIP
Phone # ( "'j' River Basin
Adj. Wtr. Body e5rnat Iman unkn
Closest Maj. Wtr. Body
� (Scale: � (;, 2• V , )
Pier (dock) length
i � 1
Fixed Platform(s)
Floating Platform(s) �n-
Finger piers) V. 12-
Groin length T I I
I
number
Bulkhead/ rap length
avg dista offshore
max distance hon
Basin, channel
cubic yards
Boat ramp
Boathou oatlift
Beach Bulldo
Other
Shoreline Length fi
SAV: not sure yes 4
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
/�. 1CA44
Applicant Printed Name
Signature, Please read compliance statement on back of permit
U
Application Fee(s) Check #
❑ See note on back regarding River Basin rules.
A
P i fficer's Printed Name
7 Xh 4
Sig re
ZS Zv
Issuing Date Expiration Date

1
Q7 X
f
ti
I
d
-----------------

1
AGENT AUTHORIZATION FOR LAMA PKSHff APPLICATION
Name of Property y Owner Requesting Permit: S • ��.1o�.J
Mailing Address:
Phone Number:
Email Address:'_
�a
I certify that I have authorized��-�^�
Agent / Contractor
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
in County.
I 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
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signaturd
Print or Type Nrame
True
Date
This certification is valid through / /

.AGENT RIPARIAN PR P RTY OMER Qrnn .
1 y the I Orin property adjacent to r) w ^ ; t1 � � }-
's
property located at his I . fNa of Property Owner)
on (Address, Lot, Block, Road, etc.)
in p,�r..l�r� Gbvri Y N.C.
�VaterY) (City/Town aridlor County)
1' nt has described to me, as shown below, the development proposed at the above location.
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)
1 understand that a pier, dock, mooringWAIVER SECTION
be t
minimum distance of 15' from my area of riparian access r unless waive, boathouse, d by me. (If gouift, or groint wiishtoback
wa a
the setback, you must initial the appropriate blank below.) e
;r' r I ---_____ _ i do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement,
owner inMnlnation)
Signature
Prrnt o�Name
M iGng Address
City/SSta_tqZp
=-E 1- s-77 -
Teteph�o�neNumber
Dvr` e ' �i`� ,..
cent Pr arty Owner In#orma#ion)
ure
W -It �� e-
nnt or Typ�e jName
Sri�S i'�y�,.r �Q
Marls g Address J � C l /
Z 'f
City/State ip
Tetephone Number
Bate
(Revised 611a,2012)

ADJACENT RIPARIAN PRpp OWNER STAT YEAtT
I hereby certify that i own ro
P perty adjacent to clrif l +
ProPertY located at (Name of Pro s
h.t,S aj pertyr Owner)
on 1h; �� ( `�� (Address, Lot, Block, Road, etc.}
(Waterbody) ' in --- Q n rl LV'
(City/Town and/or County} N.C.
e applicant has described to me, as shown below, the development proposed �,.- P P ed at the above location.
I have no objection to this proposal.
1 have objections to this proposal.
(Individual tUN AND/OR DRAWING OF PROPOSED DEVELproposing deve%pment mast till in OPAAENT
description below or attach a sit
e drawing)
I understand that a pier, dock mooringWAIVER SECTION
minimum distance of in from my area of riparian access unless waived b
pilings, breakwater, boathouse, lift, or groin must be set back a
the setback, you must initial the appropriate blank below.)
y me. Of you wish to waive
.1r", -„ 1 do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement
(Property Ownet
inTormation)
Signature
1
1 V
Print or Ty a Hume
rlrng Addres
City/� te�Zip
T-lephone Number
Dote
(Adjacent Property Owner Information)
Signature
PUT
ri or Type
Malin Add ss
15 v 1, e
CitY/State/Zip
Te%phone umber
to !L-70-17
Date 1 1 O
(Revised 6/1&2012)

Data Rec iv d
Dab DpoWftd
Ck.ck Fran
Name aP—if Holder
V r d-
Cn..k
amount
Pe it NumbeNCommenn
R-RNunM2Wlocated
Columnl
C0/umn2
C.Mann2
Coh-4
Cok-5
CSANMW
CWumn7
Column8
C.1-9
11/26/2019
11/26/2019
RobaR and Barbara Foor
_
same
Dennis Rambart
Suntrust Bank
3543
$ 200.00
GP /74792D _
GP 074704D
JD rct. 9438
JD rct. 9437
11/26/2019
11/26/2019
Carolus Buildino Co
First Bank
1407
$ 200.00