74238D - Tew

XCAMA / DDREDGE & FILL NO. 74238 A B C
GENERAL PERMIT Previous permit#
ANew Modification ❑Complete Reissue ❑Partial Reissue 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 o $7 N , j 24>0
I-1 Rules attached.
Applicant Name aldmrlG
Address Up 40 0VAc0 TDR
City 1iEAd --T-TLIL !BVAc-% State A— ZIP 7-2 461
Phone # (910) 4-4 - 2,o54 E-Mail CC+rw( &+mc.>nC}
Authorized Agent WANVA CR10V:
Project Location: County-IIZt,A/SNI c- K.
Street Address/ State Road/ Lot #(s) I lD 3
IF-A!iT ,21LD STCA W-W-T
Subdivision Ai LA
City 0cr_^,r _—T�T1Ar. Br-Ar-N zip 24469
Affected ❑ CW XEW XPTA ❑ ES ❑ PTS Acw ,,fT Phone # (91 D) 519— 9O i 5 River Basin L-u MDIER
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body CANAL (nat /unkn)
El PWS:
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body i w
Type of Project/ Activity G'viySTuu& cT A 90A i -I FT _fo
C 1 S T I AA O CAL i A1C Fc. l La (Scale: j 20 �)
Pier ock) length
Fixed tform(s)
i
oatino tfor SX, X I& -
I -
Groin length
number
Bulkhead/ Riprap I,
avg distance
max distance
Basin, channel
cubic yards
Boat ramp 1
Boathous tlift 131 x 13 "
Beach Buildo
Other
Shoreline Length
-glob 01
� ■■tt�!■■■■,I■Ali■■■■■■■■■■�.L:Caili■fiil�IViilYi�ri1■■■�
OWNER
21
_L
ent or Applicant Printed Nine
y) & f- 1 1. c.f
Signature ** Please read compliance statement on back of permit
A :Z(30 # 13 ow
Application Fee(s) Check #
I�
i y L.C--rP_ M C Gt41 94
Permit Officer's Printed ame
A G 4
Signature
3 1 9 3 Z0 9
Issuing ate Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of -Property OwnqDrRequesting Permit: �C�Yy\ S r^ -Tpx--�o
Mailing Address:—
Phone Number: -llb " ���' �c)5y --
Email Address: C e� l2� ��.�t YY�C • nt
certify that d have authorized �-�,r ; L 0-
Agent I Contractor ---
to act on my behalf, for the purposeDf-applyingfor and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at `THq6N 2
in County.
1 furthermore certify that 1 am auffiorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer, and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
PropeertyOwner Information:
Signature
lsayy) e S —
P-rrnt_or Type Name -
Title
6 a l�l D
Date
This certification is valid through

SAND DELIVER ict k
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLI.FTBOATHOUSE)
I hereby certify that I own property adjacent tQ,14 /C--,+V
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on �G�4 tj IS�C , in li r P ry t �= , N.C.
(1'Vaterbody) (Town and/or County)
Applicant's phone #:91't' 4Y� �C''� Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
-----------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Z,-e—,ez..Q V-4U-e i5l-Q
Mailing Address
51,�gAt,�, V�0- �A (, ZSs�`z
City/State/Zip
Telephone'Number
Gw"
(Riparian Property Owner Information)
Signature
lL.! ;� ! • c�TA i,,
Print or Type Name
k.,'z)-tom
Telephone Number
Signature Date Date

Mar 19 19 11:23a John Donoghue Automotive
vat [tl13 17: 23 9105790952
#AND DELIVER
PLUMBRiTE
9106428432
P.1
PAGE 02/02
ADJACENT RIPARIAN P
(PORA P.rEx�oo1e�,c R N RTX OWNER ISTATEII�ENT
I herc Cn-VB0Ap-,l Fr/BD.417 or,
by ecitify that I own prope ty adjacent to ,yt c
Name• C� ,s
P1operty located at-3 of PreropOwner) .
sf'' S��N�
--
on 4 CR-/f-F,-110SQ o (Lot, Block, Road,
6k•r.Zst� -
(Waterbody)
AppliesaNs phone f{{T0�'4 and/or County) : N.C.
�lG
Ma ding Address: .
He has described to mt:, as shown below, the developme��the is Po
posing
no objectio.Rs to ,his
must be set back a minimum (,,,stance ofr, tad that a P posing at that location, and, [
pierltnoo '
waived by me.�cn feet (I S� from � pilings / boarlift/ boathoust:
below,) (If you tivish to waive the setback, you rnusr initial file area Of ppropriate
ac
oess unless .
blank
I do not -�-----.� wish to waive
i
Co--�� wish to waive that setback requi»ment.
DESCRrMo AND/OR D' R'-------------- _---- __-
(T bePIC4,t7 irr WING OF Plzpp A b V I,OP1Vl NT:'
d/ulduelp�P� development)
(In(ormation for Pro Own -----_ J
Percy erAPP1Ying (Riparian Prop fora a
for )Permit) �Y Owner Ynforthat[On)__
�353 ��� �resz 1�.•f,�5w
Mailing Address
Signature
City/State/Zip 1 N^� N0 , U
'jS t_) Print or TypeNartte
eI� e x.,�
Signature
Date
qlo�-Gy�_q�
Telephone Number
Dace

s
�I

Daft R--W-d
Dete s/htd
Check From Neme
Name of Pennlf Holder
Vendor
Cheek Number
Cnxk
amount
I P—It Numfw.»Commenfe
Race/ t or Refund4?ee9ocefed
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C01umn2
Column3
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