68574D - Davis

rcAMA / __'.'DREDGE & FILL
3ENERAL PERMIT
rNew _ Modification ]Complete Reissue
Partial Reissue
68574 A
Previous permit #
Date previous permit issued
•ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Rules attached.
t Name Project Location: County �jryVISW i ( 5
oI L)►M h-, ti State S C ZIP Z
( * Z (r ('Z(r�5 E-/ "!Mail �A
ed Agent n O V1S�V(kb" A, q h ✓1
❑ CW >(EW XPTA KES �PTS
ElOEA ElHHF / ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA yes /
Project/ Activity
G 5-1
:k) length
tform(s)
'latform(s)
igth
n r
ipraplength
distance offshore V Olf
c distance offshore 2
innel
_�Z
is yards
P
e/ Boatlift
Ildozing
Length — 1770
not sure yes qn
im: n/a yes
yes
:tached: yes
Street Address/ State Road/ Lot #(s)
SA
Subdivision
B
City 51J� f_ 6a ZIP_�S�i
Phone i9t (� � )TZ1 S L T
ver Basin LVmbo
Adj. Wtr. Body C C1 (nat Af
Closest Maj. Wtr. Body AiLA) W
VIM I 604
(Scale: I I
g permit may be required by: TnwtM of S01 <t r &k (� ❑ See note on back regarding River Basin
ocal Planning jurisdiction) A �I t I f

A0�4sC�NT RI�A�4N Pii;QP�R'F1('c)yfll" �Sag°��►1'��T
{ I heneb that l din property: ed 11t to
i y.
i r 1 a1` ((+iaine of Property Owner)
property heated. aE L� u �,
on �0-y- :ti .l W Ck4tr" —.j j AA+ddr+esa, LA Bfot�c,R d; etc j
Aa.00��..�cJ�� N:G.
�► yj pityrrown and/ar County}
The appllcartt -has. described to mQ, :as shown boo cW, the .deve"ment proposed-. at." above
I Have no objection to ttris proposal.
I have. otr eoWrw to this proposal.
DESCRWnOO AND/OR DRAWING OP PROPQ99Gt OEVELOFiMENT
�Y�I111�p��r�d¢S�91QA!n�`Yli,t11tt5�,�JLIi7;d/#E�►lk, . j.!..�y�rpY�! �`�iitd�
Vt
WAIVEttSECTION"
I t/ttderrCd tttat,a pisr,'i5i�c)c; molting-pi(it>gs, btgt ramp, b1'�iicwater, boathouse; Uft, or,gtart
must:fld. aQC beck a rilinimumlistance 6f. tG' ircm _my. arse of riparian appess. uniess waived by
me,. (if yop aw►sh to waive ttte:sebback, yodmuaC intitai %%-apt blank: below.)
j do wish try weivetfie 15'setback requirement.
l do not wisMONVaive the:'tS setback retjulretnerit:
i ;W- Y:Owner.t t"niftlot►) (Adjacoalaropatty Owner information)
A"ng rlingMAdrir�ass:
Cr7yq10;teM, 6
.2
' lianeNumtietferr►eUati`drass T ttune:Nttmisetlem
Date Dula*
1F' TiN'�'9�,Sv'r'sE��i►� d
�Qt�( 9

ADJACENT RIPARIAN PROPERTY QWNER STATUM
I hereby cer* that i own property adjacent to � v t is
, (Name of Property Ow""
property located at -
on � (Addraas, Lot, Stock, Rand etc.)nwa.k- � .C_
t �'rfLt✓f6ii�'`t� u1Ci�Crw in ,
(W y) (Citi f1Town andlor County)
The app#cant 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 ANDiOR DRAWING OF PROPOSED DEVELOPMENT
0MUvidOW proposing devekVmnt arvst Ni in dsscdp6km below or attach a site drawit7S)
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 weived by
me. (if you wish to waive the setback, you must it>#tfat the appropriate blame below.)
6S l do wish to waive the 15' setback regwreoment
i do not wish to waive the 16 setback requirement.
(Properly Owna nworfnatlon) CAdiacettt P"wo ter Owrwr Intbrwmidonli
Suture Signature
'10 r 1-�. TkVV-
Prrnt or Type Alamo P4ht or Tvne Name
Gil 1-6'n+yt5 Tri& L-t
�� Mai+ng
'UAddressAj�va.�.,
, 2a CitylstawLip �.: r

R
North! C`,aroiina Department of Environment andNaiurai Resources
,D.v�or, of CmIal Wnay'emertt
mrly Eaves Perdue Braxton C. Davis
Wq0r
AGENT AUTHORIZATION
Oate: I
to of Property Owner Applying for Permit:
"oa t
ter's Mailing Address.
k'o
'fie Numter
Dee Ffeemar
Secretan
Name of Authorized Agent for tlis Prqwu
k ci 1 4
Agents hWfing Address:
Phone NUtuber I
tify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying
,nd obtaining all LAMA Permits necessary to install or construct the follovving (activity):
L4
,
my property located atL
cer+fficatton is valid thru (date)
Flioperty Owner Vigo*-UrO Date