74229D - Tucker

CAMA / DREDGE & FILL
GENERAL PERMIT
fXiNew ❑Modification El Complete Reissue ❑Partial Reissue
No. 74229 A B C
( DD
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 15A NCAC 714 ac)
R I h d
Applicant Name 6 Q V-% < c- K -E-m
Address D 0 o)C '? 4
City l%C V, Wate - ZIP
Phone # (ZO� 519 - 7514- E-Mail N/A
Authorized Agent �-'Ow Coo ,
❑ u es attac e .
Project Location: County N.sw►cK
Street Address/ State Road/ Lot #(s) 3
JCDTerAA/D Sitz�T
Subdivision Al LA
City (zcF A,1 J SSA $r_Aca1 ZIP
Affected ❑ CW )(EW )(PTA XES ;(PTS A CIr IJr Phone # (910 ) 44 3 — 4,FZ -1 River Basin
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
AEC(s): Adj. Wtr. Body CAAIAL- (na /ma /unkn)
❑ PWS: �
ORW: yes / no PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity CQA/S-rAIAcT / IEyj c kt.jG FA c IL, lT�e
(Scale:
ier (�
l— s1MEMEMEME NONE
oat
Groi
Bulk
Basin
Boat
Beac
Oth
Shor
SAV:
Mo
Phot
Waiv,
■■
LRft
A building permit may be required by:
( Note Local Planning Jurisdiction)
9C,r—A1%/ ,�$ (�� .9rOAC-N ❑ See note on back regarding River Basin rules.
Notes/ Special Conditions 0 14, 1 A u.• d n4 r rz L O C-,4 L S T.4 i Lr
. tJ F DF.-RA L.- a.r-U(1kL AT►oA/-V ,A 71PL 1
�LMVIC)ooper
Agent o plicant Printe Name
Signatu Please read pliance statement on back of permit
21�0 -- 32I1
Application Fee(s) Check #
r yccTt� Mc- C-1LAI Mf--
Permit Officer's Printed ame
C
Signature
Issuing ate Exl1iration D to

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 3` 2- I — I
Name of Property Owner Applying for Permit:
61a,ru 7, %vck- e, -
Mailing Address: j
�.ggCg
I certify that I have authorized (agent) kW01 to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at)
33 se��
L
This certification is valid thru (date) 3 - - z-0
✓j

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATUFTBOATHOUSE)
I hereby certify that I own property adjacent to a�(`1, TU cke T is
(N me of Property Owner)
property located at L-d t
(Lot, Block, Road, etc.)
i
on in ©-TE,� S PUM t) l Co..-,N.C.
(Waterbody) (Town and/or County)z
Applicant's phone #:7 Q� 519 75/q Mailing Address: P�, 60k � /j� J9
�Q &
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 (I5') 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)
PLEOo( ��13u
Mailing Address
City/State/Zip
Telephone Number
3—I
Signature Date
(Riparian Property Owner Information)
Signature
Print or Type Name
Telephone Number
A4 C?
Date

US MAIL
CERTIFIED MAIL, - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: 6ja rt,�I , 7_V (_-k_-e c-
Address of Property: L0l- I2- Se—C, ) 1)A S-3 SCd 071, Sr 065W t (;1� C-O.
- (Lof or Street 9, Street or Road, City & County)
Applicant's phone #:'� D�f -570 -����1 Mailing Address: P��a 1 Oox ( q3 % _
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
has described to me as shown on the attached drawing the development they are proposing. A description of drawin
with dimensions must be provided with this letter.
i Dave no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM )
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCNI representatives can also be contacted at (910) 796-72t5. No response is
considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Information)
P
i ature
v d<�(r --
Print or type Name
Mailing Address
2-9
City / State / Zip
Telephone Number
Date
(Riparia roperty Ow Information)
Sivnatur
fe
Pri t r Type Name
a7
Mailing Address
City[/ State / Zip
Telephone Number,534 ` q7"4_— .e5� �43
Date
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: [phone] FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity l Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper

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Date Received
Date De sited Check From Name
Name oI Permit Holder
Vendor
Check Number
Check
unt
Permit NumhenComments
Receipt or Ref—alReallocated
Calumnf
Colu-2
Column3
Column!
Columns
Column6
Column?
Column8
Column9
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