74377D - Bray

4 •G2S Gulf &-`-k1 C V13 x �
fY,CAMA / ❑ DREDGE & FILL NO. 74377 A B C
6JGIENERAL PERMIT Previous permit # ('
Aew !,Modification ❑Complete Reissue ❑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 I SA NCAC Z- O OU
❑ Rules attached.
Applicant Name Q(ZNy Project Location: County BEN tY
Address 1 q Z C ov E 5i ,-)E L AJ Street Address/ State Road/ Lot #(s) 14 L
City HP<rPSTEAb State 0 C- ZIP 28443 (U'J6 ;1I:'E Lry
Phone # (qlO) 508S E-Mail &,Cep 3, 6ce, Q 16r.w—Subdivision r. (A
Authorized Agent City r S T E A ZIP 28443
Affected ❑ CW AEW RPTA ❑ ES ❑ PTS Phone # ( ) SAME River Basin 4d W -x C OA 1c,_
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body ToPSA it, So.+ N P (F—Aumman /unkn)
❑ PWS:
ORW: yes / no,. PNA yes /Q Closest Maj. Wtr. Body A�W
Agent or Applicant Printed Name 15'ermit-Officer's Printed Nam
/ fQ
ol�
Signature "Please re dcompliancestatementonbackofpermit" Signature
Application Fee(s) Check # Issuing Date Ex iration Date

r
ADJACENT RIPARIAN PROP
ERTY OWNER STATEMENT
I hereby certify that I own property adjacent to L,� � 8 /V1-t Is
property located at
y .Z �a ua s', �� t%� (Name of Property Owner)
(Address, Lot, BloRoad, etc.)
on L L IN , in �N 0�A , 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)
-i--v [� i cc �x rc� Yyi j — There- vw Lt 5+" 6 -e..
al M 1 n i MU w� U of I o
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.)
1/ I do wish to waive the 15' setback requirement. (YAtte-ed +0 lb -r+ 566-�)
61
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
n ne" L"
Print or Type Name
Maili g Address
k,f 2 N V Y
City/Sxat�lzip��� 9 $ S5
Telephone Number
' 'Z9, /�
Date
(Adjacent Property Owner Information)
Si tyre
e �Sw
Print or Type Name
/'qz ���'4S
Mailing Address
PS;Ey �iG �F��3
City/State/Zip
Telephone Number
Date
(Revised 611812012)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONMAIVER FORM
Name of Property Owner:' L `� ,3 rApj
Address of Property: y Z C� ti' �� '� .e L4 km J qY-T
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
Agent's phone #:
Mailing Address:
I 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 proposal
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 Mail.
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)
. JJ"-V-v � 4-A,-X/
Signature
Print or Type Name
I q 2 Ca/ z 51 � �-
Mailing Address
(�" S- ")o N c
City/State/Zip
A(() 361- 055$
Telephone Number
Date
(Ad'ace t o wrier Information)
Signature
Print or Type Name
%9Syf rM4-11 /Zd
Mailing Address
&64�4 A,'di- /-/ e
City/State ip
9/o lt� 3 S 9 Zo
Telephone Number
4 -aa —iI
Date
Revised 611812012

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to r -, L.e �- B fV1f 's
Z (Name of Property Owner)
property located at
I -I �-b t14 S' C'/4 � �—'
(Address, Lot, Blo Road, etc.)
on T Q, V\1 , in ESN �e,2 , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
4z— 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 r i< v^ h t-
C,i vV i rt i vy, tt vv1 o f 10 -- Iae +-us e- ev1 in e.i v
S"
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.)
1/ I do wish to waive the 15' setback requirement. (1recku,e-cc) "h�- lb - --E- Se%(rack.)
I do not wish to waive the 15' setback requirement.
(Property Owner Information).
Sipature
�orieW be-
Print or Type Name
Mailing Adis A G 2
City/S at Zip
�fo
Telephone Number
1� 2-9- /i
Date
(Adjacent Property Owner Information)
Sign t re
/ f)
Print or Type Name
/ �7/ ?i
Mailing Address
City/State/Zip
9/0-�a
Telephone Number
Date
(Revised 611812012)
0�

Date Received
Date Deposited Chock From Memel
Name o/ Permit Holder
Vendor
Check Number
Check
amount
Permit NumberlComments
Receipt or Refund/Reallocated
Columnl
Column2 Column3
Column/
_Calumn5
!Wells Faro Bank
Columns
Column7
Columns
Column9
71 /310
7/3/2019 Michelle and Andrew Bra
Michelle and Andrew Bra
9067
$ 200.00 GP #74377 DW rct 8501