Spence, David

CAMA / ❑DREDGE &FILL �--_ _ -� o' 7634 A B C D
EN ERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As auth rized by the State of North Carolina, Department of Environmental Quality
and the Coastal Reso4rces Commissio in ea of environmental concern pursuant to 15A NCAC t
r-
R�a attac ed.
Applicant Name Project Location: County
Address _ Street Address/ Stat Road/ L t #(s
CityT to e ZIP
19-7
Phone #-M%il� SubdiYAn
Authorized A ent V, ►, i L1/J I I
Affected CW W ElES ❑ PTS
AEC(s): [IOEA HF (�TA
❑ UBA ❑ N/A
❑ PWS:
•RW: yes / ro(7 PNA yes / r'
City I
Phone #
Closest Maj. Win Bod)
Type of Project/ Activity
(Scale.-' — --�-
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
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions
ft@1 I W 101M• Off- Permit
[� See note on back. regarding River Basin rules.
kignature Please read compliance statement on back of permit Signatur
Applica ion Fee(s) V heck # Issu' g ate E tion Date

V
AGENT AU ORIZATION FORM FOR PERMIT APF
o,
i � 1
Name of Property Owner Applying for Per it: v t U
Mailing address:
Telephone Number:
asa) �y6-a�a
C,
I certifythat I have authorized �b ca(agent/contractor),
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
t
necessary for the proposed development of W"ilkiluov yj 14k
at my property located at
215-
This certification is valid through
(Prope pwner Information)
Signature
<a Print or Type Name
'N'
/A •
Title, do.ownel or trustee for property
Pate
6 X1 I
Telephone Number
Email Address
(date).

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to s
YA(Nam f Pro rty Owner)
property located at � 0 V r-
(Address, Lo lopb
oad, etc.)
on t c , in �,f ,N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati�
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 requiren
(Property Owner Information)
'0111� ��
Signature
>l,* 0/f/V
Print or T e Name
Maili .dress -
o
City/State ip
Telephone Numbe
z 1-16
Date
(Adjace4t Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number RECEIV "
Date
MAR 2 4 2Ct.
(Revised 611812012 Cv TY

ADJACENT RIPARIAN PROPERTI
I herebycertify that I own ro ert adjacent toy+
Y p p Y J
1 ame of Property Owner)
property located at r�6rLL . U H-4 C,
(Address, L Bloc , d, etc.)
on 0 r�~ �, , in , 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.
J p p
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
d(-iSl n�� clod
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.
(Prope Owner Inform . n)
Signat
V
Print or Type Name
. A
Mailing Address'�f � S
City/State2ip p
Telephone Number l�
. e3 /go 2avo
Date
(Adjacent Property Owner Information)
r
gRCAM
Signature
E�bu _(?.� 1 r-. C u a) Lc- Y
Print or e are'
e ? JDV
Mailing Address
City�t�e/Zip
Tele ho e Nu ber CEIVED
CJ
Da f MAR 2 4 2020
(Revised 68.1 ® iH CITY

North Carolina Division "of Coastal Management
0
)., r 6x. �-,j V---.
CEIVED
MAR 4 NN
6 l lW)CM.Mvir) CITY
(rvv
NO CAROLINA DEPARTMENT OF ENVIRO MENT AND NATURAL RESOURCES