75872D - McKenzie

�'CAMA / - DREDGjE & FILL NO. 75872 A B C D
GENERAL PERMIT Previous permit#
❑New Modification El Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 11
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 01 t'1 , 12.00
�tn�
/N ❑Rules attach d.
Applicant Name (� �)S-4 ! 1 c K��? Project Location: County
Address �� `�Q �p < A , r t �c. -� ` ( Street Address/ State Road/ Lot # s)
City ? j State PP C ZIP G2
Phone # (/CC) J 1 / E-Mail Subdivision
Authorized Agent City —3" 00 ( ZIP
AffectACW ElEW Q❑ El ES PTS Phone # ( ) River Basin
Affected
): ElOEA ElHHF ElIH ❑ UBA El N/A
AEC(
❑ PWS:
ORW: yes PNA yes / �j
Type of Project/ Activity C , s o ,,
1 r". ` `
1
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore_
max distance offshore /
Basin, channel I
cubic yards
Boat ramp
Boathouse/ Boatl
Beach Bulldozing
Other kov
1.
Shoreline Length
SAV: not sure yes
Adj. Wtr. Body --- coA mac.
Closest Maj. Wtr. Body— j w
NOUN-1111111111
Moratorium: n/a yes rip
Photos: yes 10 _ _
i
Waiver Attached: y� no
A building permit may drequired by: tvAL, c V,
( Note Local Planning Jurisdiction) \
Notes/ Special Conditions n _ 1 �; ��t,�,�A6 (\(jr � L- �\ \ n
Agent o-r Applicant Printed Name
1` i /
ature Please read compliance statement on back of permit
o () �-
--- - ��2�5
Application FeAs) Check #
(Scale: N i S )
❑ See note on back regarding River Basin rules.
PermitOfficer� Na�
Signature
L 24 Z 0 -4 o 2-} ZdL6
Issuing Dail I dirationDate

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t taraby mtoy Wt I own property SdOMA to 111 Zcif'� s
'7 aete of Pro alga Ownrh
pfOpMty baled M / % 9D A A i Ra ( • )f (�%! 1
(IWdrmw, LoR Btook Read -NC
a, T n i, RIoAl s��
(1Matsrbody) (ciWTown aadlor County)
The appke d Iw dw7 bed to ms, sm shows+ below. ern dsvabPnNrM propoead at the above loatlon.
,_k—� I heave no owscom to v* proposal
I have otysctlortt to this proposal.
DESCRIPTION ANWR DRAWING OF PROPOSED DEVELOPMENT
P w*dd LW propoabry MvukPwrrf mmM CMS in dsscrol4on bahow or attach a aft* ahp**W
t wWwft td!that a pwr, dock. ma*" 00"'�yall"Wate It Or groin must be eat daft a
attr�WM 'Illarlaa of'& kn my area of *Oft 80"n urtifaa yaMd by r,>e, (M YOU wfah fs wain
Aer setback You mwt baffler ma sp reprlaM Wm* aebw.)
I do Ah to won Dts 16' no** f*w*'nw*
1 do not so to WWO fffe Is Ofl6rd, ra*woywt

I hereby certify that 1 own property adjacent to �IG`enZis�
Property located at ���`' ( ^of„�ropeerrty 0 jner)
on Q,"R (Address, Lot, Alock, Road, etc.)
(Waterbody) in -- V (P-tD\\y , N.C.
(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)
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 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) (Adjacent Prop 0 er information)
c
S gn a r`mk". R��
s"i'C�G�
Print or �� am � C Pri Qr, p Name n
e � �. _
Mailing.Addre 7l/X rAN /v IV�ivAddress�1 �1
City/State/Zip �/ Z�, City/,S,(ateO2p n c i� &is
Telephone Number W2'�/16
I�Tele h n N�umber
Date. ---- -- —_oC e�
Date
(Revised 611812012)
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CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. — Jo s el"h -- G
41ti7
Address of Property: % 7, 0 F S�,i rt �.yr.�;� S h/ 5 -
// (Lot or Street #, Street or Road, City & County)
Agent's Name #: (t'o%;vim}�� Mailing Address: 31-)
Agent's phone I-�3/9'
1 hereby certify that I own property adjacent to the above referenced property, The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this ro sal,
P 1�
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been notified by Certified Mall
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 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)
Sign lure
Printr T pe Name
iS /3 -0-- le&-,,
Mailing Address
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City/statelzip
3j( -17-'- lei95�
Telephone Number
Date
Adjacent Property OwnerI
rmation)
Signat
Print or Type Name,
q-/O - q k3 -
TelephoneNumber
-- 4
Date
Revised 611812012

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