73503D - Williamson

XCAMA / 'XDREDGE & FILL
GENERAL PERMIT
XNew ❑Modification ❑Complete Reissue El Partial Reissue
No. 73503
A B C (D
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality n
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC / N . 1 1 0 o 12 DiJ
❑ Rules attached.
Applicant Name UAME-S R KHAI&r- UY Wll"IAMsoof
Address
City StateZIP
Phone # (g10)'140-4452 E-Mail At lA
Authorized Agent /1%oNE
Affected XCW XEW XPTA XES )(PTS
AEC(s): ❑ OEA ❑' HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / no PNA yes no
Project Location: County 9 RLk Als N 1 C_K
Street Address/ State Road/ Lot #(s) c _ 3&
LALa, ItE.*/r3uRG SIt^L�r-Lw.T
Subdivision H IA
City C CA,,., a:Tt r- &Act.L zip 29469
Phone # ( ) 5AML River Basin LwAsy-R
Adj. Wtr. Body CANAL— (natnat /O/unkn)
Closest Maj. Wtr. Body A 1 W W
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Agent or Applicant Printed me
Signatu a ** Please read compliance statement on back of permit
$boo 44-4-11
Application Fee(s) Check #
1yLrM MC 61LCIrtir-
PermitOfficer's�d Name
Signature
3 �:ZO /19 7AW I
Issuing Date Expiration Date

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to G�,m e--5
D . W) l-► -A -,,--s
// __ 11 (Name of Property Owner)
property located at 3 j D u rCA S
(Lot, Block, Road, etc.) j
on LC� � , in e uQ M_ IJ Q� l� LA C_� , N.C.
(Waterbody) (Town and/or County)
&(A Al2 eat .
Applicant's phone #: q i b ''1 " y�S2 Mailing Address: (e Lau ► h b u- ro
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------- —---------------------- ------------------------------------------------ -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying
for Permit)
16 k0_Ur1nL u v-q Sf- -
Mailing Address
60 c ja , ]:�/e Be ach Iq
City/State/Zip
Telephone Number
nature-- e
(Riparian Property Owner Information)
1- \ Signature
Print or Type Name
—)o — \CA
Telephone Number
Date

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to jam _,P S _� • Y_y i �� ak�S�`'3
(Name of Property Owner)
property located at
on C&,
(Waterbody)
(Lot, BlocQ, Road, etc.)
in Q aami �2 --� , N.C.
(Town and/or County)
Applicant's phone #: �� li% '��1 � "S Z 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.
7777- -------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
------------------------------------------------------------
(Information for Property Owner Applying
for Permit)
..3U U 11 .
Mailing Address
0cQay. -]�sie,�4 (L?���
City/State/Zip 3
Telephone Number '/
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
Telephone Number
Date

US MAIL
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: J
Address of Property: Y\ r 5 '
�G
1, (Lot or Stree #, Street or Road, City & County) �$
Applicant's phone #:N b — Q� Mailing Address:
ck-o A A-, cI.d C 0, «Sa.f A.. 0 C-
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 drawing,
with dimensions, must be movided with this letter.
I have 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. DCM representatives can also be contacted at [phone]. No response is
considered the -same as no objection if you have been notified by Certified flail.
. ... ...... .. .....
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or Iift mist be set b. 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.)
MAR 18 2019
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner Infor ation)
jary-,
ture
V�f 1�o1,►�s
Print or Type Name
l 1--�r
Mailing Address
kAo� K15\ Q-, *J C-)
City / State / Zip �g1``�I ( q
Telephone Number --A4 V- 4 q 5 2-
Date 3-5- k q
DCM WILMINGTON, NC
(Riparian Property Owner Information)
Signature %� J
b U C/C�c-,�
Print or Type Nar
) ), D /,/y G��t 'e- Q A/ei
Mailing Address
/tom
City / State / Zip
Telephone Number
Date .3-- /g,_l �
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Aftirmative Action Employer - 50% Recycled 110% Post Consumer Paper

Postal
CERTIFIED MAILO RECEIPT
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Domestic Mail Only
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In
WAS..'°
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CertiFled Mail Fee 5
$J. _II_I :J=S1
0406
Extra ervices & Fees (check bar, add fee to)
El Return Receipt amcicopY) $ •
5
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❑ Return Receipt (electronic) $ i 11 1
❑ certified Mail Restricted Delivery $ f
stm
Postmark
ED
❑Here
❑ Adult Signature Required $ ,� ; .. %�
Adult Signature Restricted Deli $ —
C:3
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Postage
$ $0.55 -
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Total Postage and Fees � 7/l_16�2
$ rt j
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$
$ ni To
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Street end Apt 11l0.,
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--------------------------

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Tracking Number: 70183090000166358962
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Expected Delivery on
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8 MARCH i by
2019 ( 8:OOPm OO
OV Delivered
March 8, 2019 at 2:28 pm
Delivered, Left with Individual
WALTERBORO, SC 29488
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March 8, 2019, 2:28 pm
Delivered, Left with Individual
WALTERBORO, SC 29488
Your item was delivered to an individual at the address at 2:28 pm on March 8, 2019 in WALTERBORO, SC
29488.
March 8, 2019, 8:20 am
Out for Delivery
WALTERBORO, SC 29488
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Date Received
Date Deposited Check From (Name)
Name of Penult Holder
Vendor
Check Number
Check
amount
Permit NumbenComments
Racal t or Re/urxO?e locateO
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Columnl Column?
Column4
Columns
CalumtM
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