71823D - Rawls

` G MA. / gDREDGE & FILL No 71823 ENERAL PERMIT Previous permit#
A B C D
ew ❑Modification El Complete Reissue ❑Partial Reissue Dote 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 15A NCAC 1 4
❑ Rules attached.
Applicant Name Project Location: County_ � �ov—
Address ' `� Y Street Address/ State Road/ Lot #(s)
City 1 1 to ZI P� r% A /� �r _�%�/` �J �% Q i
Phone #_ fTA-E-Mail Subdid ion _
Authorized Agent City ZIP
Affected ❑ CW law CRT C (S PTS Phone # ( ). River Basi
AEC(s): El b HHF El ❑ USA El WA Adj. Wtr. Body G M ` n an nkn
❑ PwS: IM)N1
ORIN: yes / no) PNA yes no Closest Maj. Wtr. Body J
Type of Project/ Activity
Pier
Fixer
Flom
Fingr
Groi
Bulk
Basir
Boat
Boat
Beac
Othr
Shor
SAV
Mon
Phoi
Wain
(Scale: \`GZo1 )
i length
MINE
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avg distance offshore
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max distance offsho■■■^
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yes
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A building permit may be required by.yv
( Note Local Planning Jurisdictio ,`(� y� _ -I `,� 1 ` r
Notes/ Special Conditions k, �( ,Y Ly � j ' ' \�`Y}} t ,[ k x r "VAS A
r Applicant Printed Name '
W-ture ** Please read compliance statement on back of perm' **
Aw)
J
Application Fee(s)
Check #
Date
1 / L-
❑ See note on back regarding River Basin rules.
ted Name
Exoiratio Date

MILL NK
a "forth Carolina DeDartrnent of Environment and Natural Resources
Division of Coastal Management
: Michael 'r. Sa- !ev. Gove-mor James H. Gregson, Director Miam G. Ross Jr., Seareter;
ALiinorized Aaent Consent Aareement
'cn U ; (j r C� �� is hereby authorized to act on my behaif
fP&,red Nzr.e or �gen1)
in order to cotain any CAMA permit(s) rewired for the property listed below. The authorization is limited to the
soecific activities cescrioed in the attached sketc^.
LOCAT ION OF PFO.,c:.T.
t o 0' IFAS- ' X:= Igy^d V2y E
049 Ts%.�cr,1 r✓ L S'i�
PROPi=RTY OWNER MAILING ADDRESS;
Ka %. -e- Lindy K41s(t s
110 2 L um i na r ,4 ",i c-
tl�llo� .SOrin� AIC 27SPHONE NO. 0
AUTHORIZED AGENT MAILING ADDRESS:
t ::ll f i`� I (` Ci..il �„� 1 tt_.�' r >1 �. i ' -f^•c"15 .
klr br C. C oG2-
PHONE NO. C4k-0 -q Sv
Signature of Property Owner.,,
ti.
Signature of Authorized Agent:
Date. �
27 Cwdi;lal ome Ed._ Wiltnk mion. Nadi, Cambia 284105-31M5
Phwe7. 910-T9&7215 \ FAX: 910-395- MO InWmet www..r=v.galmimamr*nt.net
AnEw90w=rAvXAMmMeActionEaAADn--s0%Ret—%10%Pt*Co1W1 w?aw

Narm of Individuai Applying For Patetai,t: -P�'a Lw 15
Address of PropeM, 1.2- 2 &.:5t �y(r, -Xi .r ,
-1-01 Or Street 4, Street or Road)
'."City and Cowty
hereby certify that t own prmpe�y admit to the above-referericea ro
P Pet7'. The irsdivi>
applying for this permit has describW to MI as Chown ac the A13whed drawing the deWjopme,ae
ace proposing. A descrt ion or drawing, with dimensions. should be crpv id _d with *s L
have no objections to this propfi5\
lf' Yau have obJectians to what 4 being prop, please write the D�•-
�l'of
Cobh..
saagemsat, 127 Cardinal Drive Exte=ion, Wilmington, NC :84AS or ::►i1 ''10.793.TLl3
wirbla 10 days of recelprofthts aoticat. NO rgp0R8e is considered rare lame as no obiwt6nif
vOu hove been norified by Certified Mail.
W A.MR SECTION'
1 ua+derstaad chat a pier, dock, =9riag PWW brsakwacar, o9ar :house or boar, lift Iintst k set
hck a Minimum distance Of is, from my area of riparian access . unless ►ra ived b-, ate, (if you "Sal to "'aivt the setback, you must initial the appropriate blunk- beiow ,
: do wish a
o wetve the 1 S se -back rtavire'---
i d_gngj u ish ro waive the 13' setback 'eo.I
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