74669D - Rivenbark

CAMA / DREDGE & FILL NO. 74669 A B C ( D )
GENERAL PERMIT Previous permit #
ew -Modification - Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 074, � . //(o Zoo
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC �'7
� Rules attached.
Applicant Name /W IG � C 1 Ve AJb1 Project Location: County Q�5 /�'U)
Address (/ D / Street Address/ State Road/
/LLot #(s)
CityI/1A/TI/� State At,' -ZIP -7o 1 7" Jr
Phone # gLA(067-7 2 E- ail Subdivision
Authorized Agent h'4 City / ��� ZIP 2�
Affected ❑ Cw
Ew
A )dES ❑ PTS
AEC(s): ❑ OEA
❑ HHF
C1 IH ❑ UBA , ❑ N/A
❑ PWS:
ORW: yes C!
PNA
yes /,�-o`/
Type of Project/ A tivity f
. (JIn �jt rc�� ham✓
a
C',
Pier
Fixe
Float
Fing
Groff
Boat
Boat
Beac
Othe
Shor
SAV:
Mo
Phot
Waiv
Phone # ( River Basin a V
Adj. Wtr. Body v Q e SG
CLl na nkn
Closest Maj. Wtr. Body `�Age
(Scale: / fi _ 7 r
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Pier(s)
length
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avg distance offshore J
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max distance offsoore I'
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cubic yards
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ramp
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line Length �:
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A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
❑ See note on back regarding River Basin rules.
Of L A ,� r—ICL tM,,
0 AA
Agent o plic inted Name ' 7PcOfficer's
Printed Name
Signature Please read compliance statement on back to e
lffjb Y"' c(,— logbgoq►�o--(Pm-' -11- 11 10-11-
Application Fee(s) heck# —
Issuing Date Expiration Date
Vv►o — K2o�ol �i �,��s-sod

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date K .161(17
Name of Property Owner A plying f r Pe it:
'A"' a, C, ( �,l w✓
Mailing Address:
0_6
I certify that I have authorized (agent) L , ;', L y �^- L--2taact on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
This certification is valid thru (date)
Property owner signature Late

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6110/19, 11:21 AM
RTtFlF hiAiL f2fTLfRN RE iPT �
OI1J15fON OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOT1FiCATIONtWAIVER FORM
N"of r
:.n 'ei5ofPrrplrty.
$.os cw Suto •, SteO cX RoWB City 6 Cuw.M}1
Agents film* 6 p r � T AWLin�IdtldfGiS
s. "nf'S phan'e IF ! i0
hemby oectfy Oat : own Property &dWwd UD the abOva reterer>ced PrO156rty- The "hvi6u 1
WpWV for r" pWrrdt has aescrlted to me w shorn on #0 itt&&*d. df8M1M#* dftslOff -
✓ C3 —1 have s o cbiecvuns .his prtpuut I have'*Cctiorls to itic pro-.-'41
ff you Aava 04+r+S ro wtuf is b" f+ qX"A You muse nofAy OM DAISM0 Of CeurSM Abrw$K 'Xw ,
(M" in esf V M+Ilptin 10 days of recopt of urns naOm Co~ hg6rO bW for DCM OMCr!S rs
awWabferatitM&4t=L-Cax4arbycaA*V1-889-MCOA5T.
No reapome byyinide d fte same as no ottiec*M N rao have b*M natAi4d by Cor~ AW.
WAIVER SECTION
ur4ffsund that a pier. dock rauairgf pifin9t<, brat ramp, breakwrr, er, mouse, or M nvam
be w back a rarwiwm *stance of 15' from any area of np~ stows un*ss waived by me, {If
op rAO00 t*A setback Yo� i milst inrtW ** appfupnete btw* below,;
;- i OD vnsn to wave Vv 15' settack rBquue"nsrd
1 do not yRsn to wave 1w 16 seloa(k re tame tt
Owner►) { rtan Pmpepy Own®r�fer�rattan}
C-C -I
F►1lK LY T�YE' ti+9�11F1 Rvrt nr 'r'usn Mm�fn
about:blank Page 1 of 1

Dab Rst tmd
Dab
Check From Name
Name o/ Permit Holder
Vwtdur
Check Number
Cherdt
amount
Permit NumbenComments
Revel t or Re/und/Reallocated
Column?
Coltwmr2
column3
Column#
Columns
Columml
Column?
Columns
Columns
6114Q018
_
Brwdm Grimes Money Order oft _
Mkf" Rk-b k .__ _
BOKF NA
208017766858
S 500.00
GP i74888D
_
JO rct 8240
n Grimes Mo o/
Weft Faro a
00.00
OP10466D