74393D - Warren

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AMA / ❑ DREDGE & FILL No. 74393A B CENERAL PERMIT Previous permit #
❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality a
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC � \ .
/-1 ❑ Rules attached.
Applicant Name I/C- h&r � q-
� �0.�d� , Project Location: County L.J N Sw
Address () `�yc �)04 - V-Ci Street Address/ State Road/ Lot #(s) 1
CityState ZIP C U-, 'S .
Phone # ( '`%20 359 E-Mail cEvol•s4, rr. torSubdivision I
Authorized Agent � % � � ,.� I VJ t Sl City nce S' t G Ci--� ZIP ?`i (OQ
Affected ❑ CW ;8W PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWs:
ORW: yes /(Q __, PNA yes
Phone # ( )„---_ _ River Basin
Adj. Wtr. Bodyg ,I c ( (nat k3J&P /unkn)
Closest Maj. Wtr. Body A � W VA
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A,gen r Appl)cant Printed Name
Signa ure ** Please read compliance statement on back of permit �*
CIM `� S S�
Applicatio tee(s) Check#
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Permit Offi ' ted ame
Signature
Issuing Date Expl6tion Date

i1nw;duia
Name of Property Owner Requesting Permit R " f1a f � "r f C n Jr
Mailing Address: iG ✓1 7 4�a 4z- &- b
C,hn; t,,t+E , njc ;Zg�L- I t
Phone Number -' — � U - 3 Li
Ema4 Address: f u:4 r re A +3 Caf o fin a. t r, C a m
I certify that I have authorized
AQ.rn r Cornractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: flc 4 k
at my property located at 7 04, ecc, Is k 'Fevc 40 A1C,
in 6rvu5L,"�,Ui, County
I furthermore certify that I am authorized 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
Perry* application.
Property Owner Intomlatiio`n:
p (fSignature
d I�iG�IlyM �Gi-i-e1,Te
Print or Type Name
Thye
Date
This certification is valid through 17- ,t 31 12 ©Z ' -
h}fne•//moil nnnnln 1/7

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property: %
(Lot or Street #, Street or Road, City & County)
Agent's Name #: ` c,���%'�' rry�`d�����lailingAddress:
Agent's phone #:
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 a proposing. A description or drawing, with dimensions. must be provided with this letter.
,,v, 44 ` 1 have no objections to this proposal. I have objections to this proposal.
V NFL
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. Contact information for DCM offices is
I available at http://www.nccoastaimanagement.nebweb/cm/staff-listing or by calling 1-888-4RCOAST.
% No response is considered the same as no objection if you have been notified by Certified Mail.
P
WAIVER SECTION
4 I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be se ck a minimum distance of 15' from my area of riparian access unless waived by me. (If
,.(you ish t waive the setback, you ust initial the appropriate blank below.)
r I do wish to waive the 15' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Propaft Owner Information)
Signature
Print or Type Name
cs71 !
Mailing Address
City/State/Zip
Telephone Number / Email Address
Date
Telephone Number / Email Address
to
Date
(R, arian Property Q�r erinformation)
Sig a ure
Print or Type Name
`-I-)-3 (M9&-r, " w" Gl
Mailing Address
City/State/Zip
;�C 3SZ -07,79 J
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(Revised Aug. 2014)

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CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County) j
Agent's Name #: Mailing Address: /701
Agent's phone #: O T
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 or drawing, with dimensions, must be provided with this letter.
14 L—
'61"have no objections to this proposal. I have objections to this proposal.
J
K 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. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection K you have been notified by Certified Mail.
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.
(Prope Owner Information)
Signature
ck
Prinf or Type Name
6 0, -) c;--4l -
Mailing Address
City/StatelZip
Telephone Number
U — �-b -- I
Date
Property Owner I
Print or Type Name
Mailing Address
City/State0p
Telephone Number
Date
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Revised 611 &2012

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PS Form 3811, July 2015 PSN 7530-� �g-�
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