72746D - Rochelle

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❑ CAMA / —: DREDGE & FILL ,,
ENERAL PERMIT6AM K 144r� Tff
New ❑Modification ❑Complete Reissue El Partial Reissue
No. 72746 A
Previous permit #
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 (� �(• % Z
❑ Rules attached.
Applicant Name SGi �/�C e �,ti/ I�P Project Location: County span
Address 33y Q% de Paa J, LonO
City 94innOS+Ca State .'U(- ZIP 7 $yy�5
Phone # ( ) E-Mail f
Authorized Agent
Affected ❑ CW NEW j(PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes / no
Type of Project/ Activity
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatl
Beach Bulldozing
Other
Shoreline Length Z.
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Street Address/ State Road/ Lot #(s)
1. S C' W( "
Subdivision --
City ZIP -
Phone # ( ) River Basin C- 111�'
C (3
Adj. Wtr. Body -RTW VJ ' (nat m� nkn)
Closest Maj. Wtr. Body �W w
(Scale: j "z 30� )
&,v- C�n ❑ See note on back regarding River Basin rules.
J''
Agentnr Applicant Printed me
Signature ** Please read co p i�anccee statement on back of permit
a 20094-7i
Application Fee(s) Check #
Permit Officer's Printed Name
Signature
Issuing Date Expiration Date

KC. MVMM OF COASTAL MA MWJAEWr
61
AGENT • FORIA+#F
Date
orptoperty owner{° RIi for Pervat
I certilry that I bave sulbarked (agent) €' ��" '"- - to at on my
behaK for the pmVese b'aPPIYI"g for and Obt hibg all LAMA Irtnalb icy to
%staii or construd ('ad v4)
at (my property located at)
i
property Owner Signature
IM
Ma

hereby VW 1 own property to
property Wated at � (1 KT�, i hI tjT- C' � roinn3► Own*4
onn -� c�1 � _ .)
(Waftdmdy) f frown arx#or County)
141
d�i�?j�
. '.'
WAIVER SECTION
1 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 set3acc, you must hill the appropriate blar* bekyw.)
sti
I do wiser to waive the 1F setback requirement
-
[ do not wise to waive the 15' setback requirement_
(Property Owner Information) (A,djsent Property Owner tntorrnatliort�..a
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RIP MRIAN ER
Pj- 4 # 10, r- Vg
DMMPTM AND/OR DRAWING OF PROPOSED DEVELOPMENT
(7nfflvMu8i proposing &rvwopmew MUV fiff in dweription below or adac* a site C&***
WAMR—jKMQK
I understand that a pier, dock, rnooring pilings, boat ramp, breakwater, boathouse, K or groin
m List be set back a minimum clistance of 16 from my area of riparian access unless waived by
me, (it you wish to waive the sefi)ack, you must Initial the appropriate blank below.)
-- I do Msh to waive the 15seek-K* requirement_
I do not wish to waive the 16 setback requirement
(Property Owner Information) (A jacetrt P =hTkxmafion)
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(Revised Aug. 2014)
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D.C. RecaNed
DqpO~ Cheek From ame
Neme a'Penn(! Nader
Vendor
Chsck Numher
Check emount
Permit NumbedCommevts
Rece(! w RelundRea2owled
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1/27/2019
Pippin Marine Construction
Sallie Rochelle Wells Faro Bank
4971
$ 200.00 GP *72746D
DW rct. 5851D