68546D - Epperson

3:CAMA / ;DREDGE & FILL A B
GENERAL PERMIT 1 Previous permit #
ZNew Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
>rized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
�`�GJ p p� Rules attached.
—J it Name 9?� oft- f"'�� Project Location: County F''CtJO;E
Ak 0%_Pf�kLC Street Address/ State Road/ Lot #(s)
State N C. ZIP 2_ r Ui b36 Ave 71 r 0"
( & 908-21-'* E-Mail -- ll Subdivisio
zed Agent 1�e �ipe N __ City ZIP 2-59*
❑ CW 1�4TA OQ ElPTS
ElOEA 2ftHVHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
yes /101r� PN es o
if Project/ Activity
Eck) length
9atforrillls)
ength \
ember
�5praplength Y— 14Q
rg distance offshore "
iax distance offshore "trsZ
:hannel
mp
use/
ie Length 1
notsure yes
rium: n/a yes
yes
Attached: 4ees
Phone # O River Basin
Adj. Wtr. Body I ! k--
Closest Maj. Wtr. Body
(Scale: I
ing permit may be required by: 4—/k See note on back regarding River Basin
1 n 1 ply in. L.rie 4i'rin \ n r

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date C
Name of.Property 001w Applying for Permit.
Mailing Address:
'Do rz 4A .
i
I certify that 'I have authorized (agent } �r{ 'i 2 f r\ to act on my
behalf, for the rp ofapplyiag for aad abta aia�g all CAMA Perxaita neemary to
installer construct (activity}
3
at (any property located at) �- n � � �4f% � �00,%
This certification is valid thru (date) l
Owner

ADJACENT RIPARIAN MMRTY Q ER 5TA1ElIAW
I hereby certify that I awn property adjacent to ,A.J955f
property located at
(Adder, Lot, Bloch, Road,
on ULRa F u , !n N.C.
(Waterbody)(CityfFown and/or Goufty)
The applicant has described to me, as shown below, the development proposed at the above
location.
Xr 1 have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(*KQ tal W proporsmg development M; tst !ill In dosrs*w4w bafow ofWit► a aft dnmfn
�1
J J
y 4a. ll ¢/"Pro x, P ' alb k 1�-Xc, R a-. M?e aye 4)-ocb r a lbrl f C/'Lee
WAl�iE_ R SEOON
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set beck a minimum distance of IS! from my area of riparfm access unless waived by
me. (tf you wish to waive fhe set mk, you must lnittal the appropriate blank below.)
a.4 _„_ I do wish to waive the 15' setback requirement.
I do not wish to waive the t 5` setback requirement.
Owner b4ba sdon) (Ad'acent ProoerW Owner Inform tt)
1 `e
�,..
Printor Print
hto I N ,

hereby Certify that I own property adjacent to Besse. f
. t1t tit
property located at
on V V t�'0il& . in
xtubody)
OWL)
oVM sndler County)
I
M.C.
The applicant has described to me, as shown below, the lopment proposed at the above
iocicn.
1 have no objection to this prcaposat.
# have objections to this proposal.
DESCRIPTION ANWOR DRAWL OF PROPOSED DEVELOPi1EW
(individual pfgXN tt g71e#tftiwsO NO I dMalp �Ik` tl;ii ► w tt
.ems t��l W400-OK� ��
�y �
WAi1iER SECTION
I understand that a pier, dock, nxxxft pilings, boat remp, breakwater, boathouse, lift, or grciil
must be set back a minimum distance of 15 ftom my eras of riparian access unless waived by
me. (i€ you wish to waive the setback, you must i OW the appropriate blank below.)
,,& , # do wish to waly a the t 5' SGUNWk MgWmff*nt.
i do rmt wish W waive 15#OVXwk requkwneti.
(Plop if Omw Information) (Ax4mcwK P weer Information)
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