69272D - Arial

VLAMA / _ DREDGE & FILL , 30 "t� 0 A B C D
GENERAL PERMIT I Previous permit#
New -Modification �-] Complete Reissue ❑ Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an ar of environmental concern pursuant to 15A NCAC
\� 1 Q l ' Rut ttached.
Applicant Name 1 ��'• , 1Project Location: County
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Issuing

P- I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBO_ATLIFTIB�OATHOUSE)
I hereby certify that I own property adjacent to ?2lq;oe A-6 AL
(Name of Property Owner)
property located at �_�� Noms %Ly Q .
(Lot, Block, Road, etc.)
on l� N KS 1�1�Ar�w I< , in
(Waterbody)
Applicant's phone #:
(Town and/or County)
Mailing Address:
I le 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.)
� 1 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) �l
AA� d'C''�� w. rN 7Df' r) Ax. d A,elgc- g -2� -/ ? )PdotJ
-------------..-----------------------------------------
(information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature Date
.-------------------------------------------------------
(Riparian Property Owner Information)
��- ----------- - Signature
Print or Type Name
/,2 - z/©rS
Telephone Number
i c. it _Ai
Date

�t
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to P
rtdt,p, Qyt-. is
(Name of Property Owner)
property located at 11 l� /9�r�AYt D11t�
(Lot, Block, Road, etc.)
on �d A9L`S An� , in -rQaS4IG 13eQCJ3 N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 910 h ZI S9 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/mocq'ing 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
OW ✓ I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
Sec tttacheJ
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
Telephone Number
Signature
Date
(Riparian Property Owner Information)
Signature
Print or Type Name
--c'1P, 220?57 9�o Sim 371
Telephone Number
Date

A7iA.
RCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date L 4 l (D — �
Name of Property Owner Applying for Permit:
C , .A.e- `
Mailing Address:
s mG 2.bM6
I certify that I have authored (agent) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 6X�V' ,
at (my property located at) k � 4 Z b N , kPAJOtiS G \ Ll��
t c Fs�� l , 0 C, 'a?) 44 5_
This certification is valid thrn (date) (1,3 1- XD
C
Property Owner Signature
0-16—1
Date
400 Commerce Avenue, Morehead City, North Carolina 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement,net
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

MRO
Date Recelvad
Data
De oskad
Cheek From
Name of Permit Holder
Vandw
Chack Number
Cheek amount
Permit Number/Comments
Race/ t w RatundtReallo—ted
12/7/2017
12R12017'
12/7/2017
Allied Marine Contractors/Hal Fogleman
Southeastern Coastal Construction Co.
Pridis Anal
First Citzens Bank
South State Bank
6271
$200.00
GP 69272D
GP 694300 _ _ _
GP 69271D
JD rd. 5413D
CS rd. 5454D
JD rct. 4750D
_
William & Elizabeth Dozier
Scott & Jean Jamison
10514
6272
$600.00
$200.00
Allied Marne Contractors/Hal Fogleman
!First Citizens Bank