68579D - Caveness

CANri'� / I�60
A / 'DREDGE &FILL „p �y �
-. GENERAL PERMIT I �Previous perrmit #
[ A B y C
New Modification []Complete Reissue ❑Partial Reissue Date previous permit issued =k
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC .110o
❑ Rues1 tta hed
Applicant Name IPA(G4SL, kvv, J CS
Address 4tr6 1Z� 6f'e;c(Gw Tit- Ep4c-7'C"-
C ity �'+%�jN1 �j— State lOL ZIP 7 2' 4 4
Phone #f1la)�j — WE
D -Mail /
Authorized Agent
Affected ElCW EW ElPTA XES ElPTS
AEC(s): ❑ OEA HHF ElIH ❑ UBA ❑ N/A
ElPWS:
r
ORW: yes / no PNA f es / no
'�']c_ a c
Project Location: County rN DIE(--
Street Address/ State Road/ Lot #(s)
Subdivision
Phone # ("'j`--' River Basin
Adj. Wtr. Body ,( an /unkn)
Closest Maj. Wtr. Body Tt�S/tl l- -so
Fee(s)
■�■■■■■■■■wry■■■�■■■■■■■wi�ri■■■■■■■�■■
or toplicant Pripted Name
r.�
Pe Offs is Printed Name
** Please read compliance statement on back of permit **
Check #
Signatuglz
to •Z�• r�- 2•�/�--
Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date _ f' Z 1. Z U! 7
Name of Property Owner Applying for Permit:
:Mailing Address:
1106 Sf- 6e-e eli✓oe-4L) 7>Vr 4 e-
f
I certify that I have authorized (agent) -rv-i T PI�», h to act on my
behalf, for the purpose of applying for and obtaining all LAMA Permits necessary to
install or construct (activity) a- �u C IL k e.-,
at (my property located at) qC)C-lc 5+- (_.t'�2� V► etiu t ✓1 v,
1+r1Mp5.1-fA-,d, Me- z ,?) q K 3
This certification is val thru (date)
Property Owner Signature Date
RECEIVED
DCM WILMINGTON, NC
UC i 2 5 2017

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 101 "e ( 9 (+ Z s ti/f h La ve v1P < s 's
(Name of Property Owner)
property located at i V--:_
(Address, Lot, Block, Road, etc.)
on !'re e tom_ in 14?vyiP.5 <i . N.C.
(Waterbody) — (City/Town and/or County)
The 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)
�uCl� he,e-off e, fan 1 pvtpe'f� kra*Stl tf n.e, -!t
C,v e �e k .
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.
do not wish to waive the 15' setback requirement.
(Property Owney#nformation _ (Adjacent Property Owner Information)
��-��� sttSa•n Ca+-td, I t
.Silature
/y1 r L 1,1", o ( (li VLO i?Q SCi
Print or Ty a Name
Mal
li g Address
I���v�t{r'r�c Nt_ ZY3�-1K3
cit)qStat ip
e)10- -2,0- 2,2K
TO Number/email address
_gT �) 7
Dare
`Valid for one calendar year after signature'
Si'
rlr 0 9P.
Print or Type Nypme
Ali„ t
Telephone Number/email address
(nevi-,;At6 "?d E?6? 4)
DCM 1NILMINGTON, NC
OCT 2 5 Z017

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to PI, I VI" , � ` " Z � lK fi; C,(2 (10-4,V 4; s
(Name of Property Owner)
property located at
I
(Address, Lot, Block, Road, etc.)
on in ri i r N C
(Waterbody) ( ity/Town and/or County)
The 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)
h
e v .
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 Ownp, reformation)
Si ature
/II Lon/ e 1 I�6� vim' " -1; S
Pnnt or Type Name
qUP � . (Y ,� P k view N i i,Y
Mailing Addre s
City/stat ip
c/lu S24)-Z7-ilf�
TelephotrIq � Nrm ber / email address
Date
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
51 na re"
I -,;LA 6t-' T- c
Print or Typ Na e
4 rt)ID . UreARV ietil Doti
M fling ddre
u
s
a wA� as
-brad_ L 4A�
Qty/Stat&
MO- [o rt- 015 BLa
Telephone Number/email address
Date
(Revised Act ftjVtD
DCM WILMINGTON. NC
u�;i 25 2017

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WIRO
Date Received
Dab Dapo~
Check Flom em
Nameo/Permk Nokiw
Vendor
Check Number
Cheek amount
Permit Number%Comments
Receipt or RetundrReallocatW
10/27/2017
Pippin Marine Construction LLC
Michael Caveness
Wells Fargo Bank
4489
$400.00
GP 68579D JD rct. 5072D
GP 68580D JD rct. 5073D
GP 69269D _ JD rct. 4747D
1 GP 68568D CS rct. 5107D
GP 68564D BS rct. 5332D
10/30/2017
Chris Connaway
Kenneth Moyer
PNC Bank
1494
$200.00
10/30/2017
Jerry Ennett
Mike Williams
Coastal Bank & Trus
501
$200.00
10/30/2017
James or Donna Jones
Jason Hoffmann
PNC Bank
2878
$200.00
10/30/20171
1 Grice Construction
lAngela Smith
I BB&T
116191
$400.00