73575D - Davis

CAMA / DREDGE & FILL 3. NO. 73575 A B c
ENERAL PERMIT Previous permit #
New '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 15A NCAC
,r- � ❑ ules attached.
Applicant Name i I i S Project Location: CountyjAdell—
Address O 2 c� 1 o4- Street Address/ State Rod Lot # )
City -i/11` State zl `5 % 7i j l� i { ( ►^
Phone #11-!�O G-7 - Q' E-Mail Subdivision
Authorized Agent ✓ C zip 2
Affected ❑ CW ❑ EW ❑ PTA �S ❑ PTS Phone # ( I — River Basin w '
Affecte ❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
ORW: yes (no) PNA yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platforms)
Floating Platfor (s)
Finger pier(s)
Groin length
number
Bu hea iprap length—,
avg distance offshore_
max distance offshore
Basin, channel
cubic ya
Boat ram
Boatlift
Beach W
ing_
Other1-1
Shoreline Length-
SAV: not sure yes ._
Moratorium: n/a yes fio
Photos: yes
Waiver Attached: yes o
A building permit may be required by:
( Note Local Planning jurisdiction)
Not / pecial Conditions
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Please readcompliancestatement on back of permit*
Adj. Wtr. Body � wn� (na /man /unkn)
Closest Mal. Wtr. Body 4� ��Gt '�' 0 f !Q
(Scale: i i,
❑ See note on back regarding River Basin
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATH'OUSE)
I hereby certify that I own property adjacent togoar is
(lYame al'Property Owner)
property located at A/,,'i >j
(Lot, Block, Road, etc.)
on ��os,s-/ ��,✓� , in s I�OH.✓i",
,r`...- � .� , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: ZS-z' 6, 71 {4Z: Mailing Address:_ A9Z
�i•� �,rr ✓, �t/l ZSSG Z
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 I 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)
rOl�f�-28 r00
Mailing Address
A rrr lU e
City/State/Zip
Tele phone Number
Si ture a J a0,7.0 Dare
(Riparian Property Owner Information)
Signature
Print or Type Name
Telephone Number
�d 'L o
Date

A
TxJ
��i�
IrCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
AGENT AUTHORIZATION FORM
Name of Property Owner Applying for Permit:
�13, S A $.AJ tS
Owner's Mailing
Address:
h?.r
Z-
Email: T P-5
Phone :,I nt;- (e, % l - 16 2 9
Name of Authorized Agent for this project:
Agent's Mailing Address:
�.s 60/0Pl4%,-- �L
462 ip &d, AAC Z 8VC13
Email: Crodh 46k-1 0-,:) 60,2
Phone
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, and obtaining all CAMA Permits necessary to install or constructthefollowing (activity):
�rA- id rt.JGyJ,¢-�l ��i✓h �/>t{'�� F�/f�as a..� �9.,,���✓rtr-d. 6 �i! , !`!L rci��� �, ��
Project Site Address: 6 3 6, /— 64- K' JSto," �t)od
a AA L.::�
--T I�Ln:=A
Property Owner Signature
Date*
*This certification is valid 1 year from date signed by property owner.
N.C. Division of Coastal Management
127 Cardinal Drive Ext., Wilmington, NC 28405
Phone: [phone] \ FAX: [phone] Internet: www.nccoastaimanagement.net
An Equal Opportunity 1 Affirmative Action Employer

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIED MOORING PII.INGSBOATLIFTBOATHO USE)
I hereby certify that I own property adjacent to+s
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on lma3.a -4 II /d On .��.� L � , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:_ Mailing Address: 102 tAbUL.4'k l�r,
Iw ?.a /VC �BSty z
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 / boadift I 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 3%
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 (Riparian Property Owner
for Permit) In
l0C2, 8A- .b le b t-o io k Dr
Mailing Address
City/State/Zip
Te phone Number
S gnature Date
Print or Type Name
a�C2 (y -.15 7 q
Tele h ne u/�ber
V
,Date

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2/1312020
nnaway
Jane Davis
PNC Bank
2094
$ 400.00
GP f73575D
JD rct. 10962
2/1312020
Allied Marine Contractors LLC
James Sum , III
First Citizens Bank
8697
$ 400.00
GP i74879D
JD rct. 10828
2/1312020
Coastal Marine Piers Bulkheads LLC
Pigeon Properties. LLC
Wells Fargo
23218
$ 200.00
GP #74869D
TMc rot. 9757

Dafe Received
Date Deposited
Check Fmm (Namel
Name of Penn/f Holder
Venda
Check Number
Check
aunt
Permit Number/Commanb
R ' t or R.W dM..di affi d
Column_t
Columnl
Column)
Columnl
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2212020t
221/pp
Chrrs Connavray Mmay Order (ratumad check) _
iChris Connavra Mme Order returnM check tee
Jane Davis
Waft F Bank
18: 79051
400.00
Mary order hr rekanM oleok' GP A3575D (21?l7D)
—,r C
PA rt 9765