72304D - Sterbenz

CAMA / ❑' DREDGE & FILL
GENERAL PERMIT
4New Modification ❑Complete Reissue ❑Partial Reissue
No 72304 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
❑ Rules attached.
C QD
Applicant Name �5r-r—P-M.n/z Project Location: County RRtApis -+IcK
Address 31 M 1li..t.1E>L #2V Street Address/ State Road/ Lot #(s)) 7
City FAQMINGOI►�.� State_/ ZIP 11 5 -AIANJ I15u a --Sf ivl<.-r
Phone # (51&) 694 - 3035 E-Mail M12 r-.... ftx l 96 jM",1•`$abdivision Al _/A
Authorized Agent IZOA1 City OC"AP 1�sCOn 13r-A(a ZIP 2_9'4-G 9
Affected ❑ CW XIEW XPTA ❑ES ❑ PTS Phone # (4-'l0) 514 -9072 River Basin J vtv&m><
AEC(s): ElOEA ElHHF ❑ IH El URA El N/A
❑ PWS:
Rk'A Sin oyvt
Agent or Applicafit Printed Name
Signature '**F ease read compliance statement on back of permit"
�C
1)0 4� /012-3
Application Fee(s) Check #
Adj. Wtr. Body CA14Ak.' 23 (nat m� an /�)
--rq L_r� Mc- GIA.IRIm-
Permit Officer's Printed ame
Sig
VnaturgZ & I Io�ZV�9
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER UUMENT
I hereby certify that I own property adjacent to _ C ie �erheAZ s
_1 (Name of Property Owner)
property located at Lit' ZcJ Cu r�c� ( 23 p( ark I p / R7
/ (Address, Lot, Block, Road, etc.)
on _C 11 Nli ( Z3 in 01-&r3let Ss Le N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I 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)
5' YZ x I Z, Pi 1�_ V'
6t7ftac- ed 4o S' x 16' Fl vc�i vt duce
LAJ A- \ 1 �e l f�cuv\p
CSF_, &+�gckeA c.mw i Y15 1
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.
�_ ` 1 do n41wish to waive the 15' setback requirement.
(Property Owner Information) (Ad'acent Property Owner Information)
Signa re Si re
Print o pe Name Print or Type Name
/ M A -r- RJ -111(0 C.GkAaUJGa_ S Ind .
Mailing Address 73 Mai g Address c_ z,bDS-?
City/State/Zip CitylSState/Zip
'-/C (C4 _ o70 33&-66'CQ l lq
Telephon Number
s,�iq
Date
Telephone Number
Date R CtIVED
(Revised F IMJ9
I
DCM W►LMINGTON, NC

ADJACENT RIPARIAN PROPERTY OlM §TAT UNT
I hereby certify that I own property adjacent to _FUg e-.✓►& '5+ . rr 60A z 's
(Name of Property Owner)
property located at_ L o Z q CQ n U 2.3 p/ f -- /a /'P Z
(Address, Lot, Block, Road, etc.)
on ��tr?r�� , in 06&0 A l le , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I 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)
SY2 / x i Z' Pi'rp
ct +i kc,hcxd - o- S ' x 16 / 41ca4;vJ coo ck
('V; k 18, Pal. Mp
see, a dMx'tn%)
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)
6 7�y
Signa re
E'uQ ✓IE S-ferbe.iz
Print otrType Name
Mailing Address 117
w
Ctate2
p
Tel hone Number
617 / 14
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name (
'�; c titYtl1bvV-5 -Jr
Mailing Address I
orl gl C-
City/ tate/Zip
1ZJ- Y 04- z Z21
Telephone Number RECEIVED
Date/ TI I � i 019
JUN 2
(Revised 611812012)
DCM WILMINGTON, NC

I
I S' b FPSET"
121 (bier
IS' vf:4::sET
RECEIVED
JUN 2 5 2019
t MVC-Q`t`i OP C606 PuF-c.r---%-L
DCM WILMINGTON, NC

Check
Date Received
Date NTosited Check From Name
Name or Permif Holder
Vendor
Check Number
amount
Parmif NumberlComments
Receipt or Re/undlReallocared
Columnl
Columnl
Column3
Columnl
ColumnS
Columns
Column7
Column8
Column9
7/3/2019
7/3/2019
_
Eugene Sterbenz/Ronald Sterbenz Eugene Sterbenz Chase Bank 1623! $ 200.00 GP #72304 TMc rct 8763