69353D - Anderson

AFE
/ ❑DREDGE & FILL �'13 5� A B C D
GERAL PERMIT Previous permit #
ChewModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources n
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ` G
A -- ❑ R les attached
Applicant Name f -� �iV�- �!1 Az,�- /�Yl
Address V Y\ Ci- "C\1e
City ` StateAL ZIP
Phone # E-Mail
Authorized Agent S S
Affected ❑ Cw NfW A4TA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
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Agent or Applicant Printed Name
i
Signature Please read compliance statement on back of permit"
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Application Fee(s) Check #
Project Location: County- � V1►�AA:Z I( -
Street Address/ State Road/ Lot #(s)
P�a7o.
Subdivision
city((or" n ,����f t�tr l� zip
l one River Basin M7eV
Adj. Wtr. Body Gt ((�� �4'�l ( at) man /unkn)
Signature
Issuing
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oil
Expirdtion Date

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Paul B. and Page Conway
3313 Landor Rd.
Raleigh, NC 27609
A Signatu f
❑Agent
❑ Addressee
B. Receive by (P t ted Name) C. jDate of Delivery
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Expresso
❑ Adult Signature
❑ Registered Mail
II
I'IIIII
IIII
I'I
II II
II
I I
I
III
I
I I
I
III
ElAdult Signature Restricted Delivery
El Registered Mail Restricted
❑ Certified Mail®
Delivery
9590 9402 1912 6104 4428 22
Certified Mail Restricted Delivery
O Collect an Delivery
ReturnMe chandisept for
2. Article Number (Transfer from service label)
❑ Collect on Delivery Restricted Delivery
❑ Signature Confirmation —
7005 0390 0003 5187 3531
El Insured Mail
;se� Mail Restricted Delivery
El Signature Confirmation
Restricted Delivery
PS Form 3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt

44.;A,
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date June 6, 2017
_me of Property Owner Applying for Permit:
Gene Anderson
Mailing Address:
2804 Wind Bluff Cir.
Wilmington, NC 28409
I certify that I have authorized (agent) Joel Klass to act on mN
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) replace ramp & floating dock ,
at (my property located at) 39 Isle Plaza Ocean Isle Beach
This certification is valid thru (date)
Property Owner Signature
Date
400 Commerce Avenue, Morehead City. North Carolina 2855
Phone: [phone] \ FAX: [phone] \ Internet: www.nccoastalmanaaement.r
An Equal Opportunity \ Affirmative Action Employer — 50% Recycled \ 10% Post Consumer Paper

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Gene Anderson
(Name of Property Owner)
property located at 39 Isle Plaza
on
(Waterbody)
(Address, Lot, Block, Road, etc.)
in Ocean Isle Beach
(City/Town and/or County)
I
N.C.
The applicant has described to me, as shown below, the development proposed at the above
location.
—1l-', 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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.
(Property Owner Information)
Signature
Gene Anderson
Print or Type Name
2804 Wind Bluff Cir.
Mailing Address
Wilmington, NC 28409
City/State/Zip
Telephone Number / email address
Daic,
(Adjacen 'Pr perty Owner I oormatie
Signatu e
Joh Foust
Print or Type Name
2106 Pinewood Cir.
Mailing Address
Charlotte, NC 28211
City/State/Zip
Telephone Number/email address
Date *
(Revised Aug. 2014)
'Valid for one calendar year after signature"