74757D - Singh

-LAMA / DREDGE & FILL No. 74394
A B C
GENERAL PERMIT Previous permit #
4�4ew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality tt''
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC O -T R . ( , 0C)
'� --� ❑ Rules attached.
Applicant Name )G-� i_, _r Project Location: County \S ram.. c I �
Address A J.e—
Cityy ( e e � S 6r, r C.;' State N�L- ZIP Lt 0-1
Phone # [phone] IQ 2 Cs E-Mail
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS
AEC(s): I�J OEA �a HHF -41� IH ❑ USA ❑ N/A
❑ PWS:
ORW: yes / rV PNA yes
Street Address/ State Road/ Lot #(s)
a C✓ 3ItC�' 17
Subdivision
City Oc cc' kS kt a'f � � h ZIP 2 a-y foci
Phone # (-
River Basin L ,..,.1O­
Adj. Wtr. Body J\ y t k-1 C-� c, - (® /man /unkn)
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Agent or p icant Printed Name
Signature Please read compliance statement on back f permit
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Application Fee(s) Check #
Permit Officetr�tf�i ed Name
Signatur
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Issui D e E iration Date

ICAMA / I I DREDGE & FILL
GENERAL PERMIT
I ]New LiModification L_IComplete Reissue 111'artial Reissue
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
/ �j Rules attached.
_,dlicant Name ad � 011 J � +`'�1 Project Location: County_ 1? N.•�,Sw�C le
Address ll � / �* /� r9 /1 � , d f� ' e, Street Address/ State Road/ Lot #(s) L110
State Al C ZIP.Z
Phone # (3?A 2_'l _2' ` ; 6Fax # (___ )_
Authorized Agent
Affected I 1 CW U EW ❑ PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ M ❑ UBA F 1 N/A
❑ PWS ❑FC:
ORW: yes / no PNA yes / no Crit.Hab. yes / no
Subdivision
City cea-� rSZ{ &9<c i ZIP
Phone # (_) River Basin c-/"h
Adj. Wtr. Body eLIA,N 4 c- CC Pam✓' (nat?/man /unkn)
Closest Maj. Wtr. Body %L e." aC t°.9 -✓
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nt or Applicant Printed Name PermitOfficer'; /S'ignn/ature
r . t A l G It ON , `TU
Signature Please read compliance statement on ba �r t Issui g Date Expiration Date
Application Fee(s) Check # Local Planning jurisdiction Rover File Name t/

NC DIVISION OF COASTAL MANAGEMENT
SANDBAG REMOVAL NOTICE
I. �\ A..�� �o �. ` t2 , understand that sandbags are temporary erosion control
structures that may remain in place for up to eight years after the date of approval if it is protecting a
building and an associated septic system, a bridge or a road. The property owner shall be responsible for
removal of any portion of the temporary erosion control structure exposed above grade within 30 days of
the end of the allowable time period. Any portion of the temporary erosion control structure that becomes
exposed above grade after the expiration of the permitted time period shall be removed by the property
owner within 30 days of official notification from the Division of Coastal Management.
In this case the sandbag alignment may remain in place up to: Permit No.
Address of the Structure Being Protected:
Property
(Firm, Corporation or Individual)
If the property is owned by a Firm or Corporation give
the name of the officer or authorized representative:
Print Name
Signature
Date
If an agent is obtaining the permit on your behalf the following section must be completed in full:
I, , give permission to,
Print owner or Officer Name Print Agent Name
to act as my/our agent in obtaining a CAMA General Permit to place sandbags on the property noted
above.
Owner or Officer Signature
Print Agent Name
RECEIVED
NOV18
DCM W►LMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Don ) d s
(Name of Property Owner)
property located at 1��(Q �Lr �� ?�rcl S{-
(Address, Lot, Block, Road, etc.)
on i l{\c,,,1i(. UCea,-- in iJCa2 �) S<I� , N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above location
V/""- I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Signature
Print or Type Name
a Addre s
tate2ip
�t(' — Z-1c) 3 L��
Telephone Number
Ll
Date
&L U7 U-V1
Si ature
t krde" n-)Cw- 6v-1(ka"s
Print or Type Name
Mailing Aid ress
C-,301o�7 3
Cit)VStatelZipl
70L, Lcl4 'IG t
Telephone Number
ti - tip- 1C1
Date "DECEIVED
(Revised 6/1&2012)
8 209
DCM WILMINGTON, NC

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to � -- �� 's
(Name of Property Owner)
property located at . '-�.i O L-:�-- t....:1„� yZ—
n1 (Address, Lot,�lock, Road, eta-L
on t-1� F�t.� • C- 'i .)Cc:a, , in 'AZ , N.C.
(Waterbody) (CityiTown and/or County)
The l' ant has described to me, as shown below, the development proposed at the above location.
V/ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 a k, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
tgnature
Print or Type Name
A, i�Address
rate ,
Telephone Number
U-kLA--
Date
nt Property OwWlnformation)
Signature S r`e/ Ie
j�-enn�r'no
Print or Type Name
Mailing Addre
R�r't/^X,t Al 2 ,-)a l % RECEIVED
City/State/Zip
NOV 1 8 2019
Telephone N mb r
, 9
Date —DCM WILMINGTON, NC
(Revised 6/1NO12)

Ch dk
_Date Deposited Check From (Name)
Name of Permit Holder Vendor
Check Number
amount
Permif Nlunbel/Commeufs
Receipt or Refund(Reaflocated
Columo2 Column?
Column) i_ Column5
Co1umn6
Colurm7
Col_u-8 _
_
Column9
11/27/2019 Mr. Dan Souther same SunTrust
4952
$ 400.00 GP 74394
BB Mt. 9451D