74872D - Turner

VCAMA / ❑ DREDGE & FILL
No. 74872
GENERAL PERMIT
A B C D
Previous permit#
XNew Modification ❑Complete Reissue
El 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
❑ Rules attached.
Applicant Name r 1 c ^� t
Project Location: County
Address ( I
Street Address/ State Road/ Lot #(s) 4 } -4
CityState tJ C ZIP
Phone # (_") i E-Mail . ;i� ^r i; k
Subdivision
Authorized Agent ►- -A to
City : i I L . i ZIP ?4 r-,
❑ CW N EW PTA ❑ ES ❑ PTS
Phone # ( I i 1) 9 i ' (- 1 _ River Basin
Affected
❑ OEA ❑ HHF ElIH ElUBA El N/A
AEC(s):
t V-4 Vd ( nat /man /unkn
Adj. Wtr. Body )
❑ PWS:
Closest Maj. Wtr. Body
ORW: yes / no PNA yes / no
Type of Project/ Activity v
icubic
yards
�tD
♦
J ��
•a. ��
G !_
- .. •, ...
Agent or Applicant Printed Name
Signature ** Please read compliance statement on back of permit
•*
A 20 o it A y
Application Fee(s) Check #
—�-- �A
IYI
f�iZ ►"IGC'IKtRE
Permit Officer's Printed Name
Signature
I 1 l2o CP /Aq 120
Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Svc- .M
s
property located at � 5�,,.,� ,,,,, �� of Property Owner)
on (��„/-� (Address, Lot, Block, Road, etc.)
(Waterbody) ' in \'-J:\r-:\,."�c>v-\
1 (City/Town and/or County) N.C.
-w
T 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)
ov-
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 set ck, 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) (Adjacent Property Owner Information) >J%
4nVuree-JL����
Si ure
m . 1 Jr-w'e r- I�
Print or Type Name t nB Pnnl r Type Name
ul S fit. nM nre.� i�as K
AhMiafig
1 qdAd-are: s�s
p/� Mailing` d� ress
Zi/CiStip
C
3,�(
Telephone Number Telephone Number
a n aoao
Date ¢ Zb
Date
(Revised 611812012)

ADJACENT RIPARIAN P OPERTy OVYNER STATF.RIIENT
I hereby certify that I own property adjacent to
property located atTv f r� r
t{ � t e.; � (Name of Property Owner) s
on �L•n�vtif (Address, Lot, Block, Road, etc)
s (Waterbody) ' in s-�(CI�Town
a�ndtorCounty) N.C.
The applicant has described to me as shown below, the development proposed at the above location.
€ — i I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION, DRAWING OF PROPOSED DEVELOPAAE
(individual proposing development mi��Ocl!/tin description below or attach a �'
site drawing)
understand that a pier, dock, mooringWAIVER SECTION
minimum distance of 15, from my area of riparian access unless waived b me.
pilings, breakwater, boathouse, lift, or groin must be set back a
the setback, you must Initial the appropriate blank below.)
Y (If You wish to waive
-----____ _ I do wish to waive the 15' setback requirement.
----- .�. I do not wish to waive the 15' setback requirement.
(Property Owner Information)
i"ature _
Pnnt ar F
pe Name
15Y
Mailing Address x, f
:1-3C)5
Date
(Adjacent Property Owner Information)
Signature i
AAark Maynard
Print or Type Name
10 S Cardinal Dr
Mailin Address
gilmington NC 28403
city/state/zip
910-251-5030
Telephone Number
2/1 /2020
bale
(Revised 611 &2012)
Tt\

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: jV�r
Mailing Address:
Phone Number: a1 i j - 3g
Email Address:
I certify that I have authorized
Agent / contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: t`t+^W.. �r w ���•�,...�
at my property located at,�
in WesCounty.
/ furthermore certify that l 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
permit application.
Property Owner Information:
Signature
�ue M • lur-Akr'
Print or Type Name
Title
c2 l �o l as ao
Date —�
This certification is valid through / /

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