69375D - Frick

<CAMA / ❑ DREDGE & FILL 6
A
3ENERAL PERMIT Previous permit # B
New Modification Complete Reissue ::Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources I' /�
�oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC b1 �? i � oo
❑ Rules attached.
it Name �,(`e,w (� _ Project Location: County (� Asim C �
G Street Address/ State Road/ Lot #(s)
-� t,o(
l State. ZIP
` ()' 0 0 _, E-Mail Subdivision r
:edAgent 611 i I�CM-0 , 'AA (A V� (6r' city G(nar 4 ; It iJ(u t �' ZIP gL�
w [kW �TA ❑ ES PTWSS ( � APho�ne�# 11 Q
( ) i gb ' 1 1Z River Basin [/c4ffirJ
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body �� V1/�i ( fit) /i
❑ PWS: �
MIA) PNA As / no Closest Maj. Wtr. Body Ai W Ii!/
f Project/ Activity
ck)length
atform(s)
Platform(s)
ier(s)
ngth
mber
/dice
ength
offshore
offshore
cannel
sic yards
ip
se/ atli �_
ulldozing
00
e Length '
notsure yes
ium: n/a yes V
yes 6
\ttached: es no
I
ig per itit may be required by:
-ocal Planning lurisdiction)
0
"fo J- Ouav, 1Sk 1?rat �1
(Scale: ' _r
1
❑ See note on back regarding River Basin rL

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Is
(Name of Property Owner)
property located at ,L��?/-�Gr
on
(Waterbody)
(Address, Lot lock, Road, etc.
in N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locati
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 ba
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w
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.
(Adjace Pro
Print or Type Name
Owner Information)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �lqii e-L2 YJ ! I
e-> ZI-3- <- ; (Name of Property Owner)
property located at
(/
/ / (Address, Lot, Block, Road, etc.)
on AjQi1"/ , in ::& t, A,- - d— , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
x_ 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, boat ramp, 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.)
�L I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signpre
r,144
Pro arty Owner
P7
/114
I 1 %Uvycl G_ � c�
Print or Type Name
Print or Type Name

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:AJ,4e-� r/
,
Mailing Address: �� J JX 0 0
I
Phone Number:
Email Address: all
certify that I have authorized 4,(,# f
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ewd
at my property located at�4—
in IVK" County.
l furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
Print or Type Name
Title

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Origin
SHALLOTTE NC, 28470
Destination
WINSTON SALEM NC, 27106
Status
In transit
Tracking Details
August 31:57 pm Notice Left (No Authorized Recipient Available) in
WINSTONSALEM,NC - In transit TRACK NOVA
Thu Aug 03 2017 - WINSTON SALEM, NC
August 3 8:45 am Out for Delivery in WINSTON SALEM, NC - Out
for delivery
Thu Aug 03 2017- WINSTON SALEM, NC
August 3 8:35 am Sorting Complete in WINSTON SALEM, NC - In
transit
Thu Aug 03 2017 - WIN§"4W♦ RWormats
August 3 7:20 am ArrivecRRQY~WON SALEM, NC - In
transit 9999 9999 9999 999
Thu Aug 03 2017 - WINSTON SALEM, NC
iz9999999999999999
August 2 9:07 pm Depart@822MBelftal Facility
GREENSBORO NC DISTF48e. 999�ITER- In tr
Wed Aug 02 2017- GRE $4C DISTRIBU
August 2 7:45 am ArrivedfA.l> !8naI Facili
GREENSBORO NC DISTRIBUTION CENTER- In
Wed Aug 022017-GREED JAWWJ
August 110:45 pm Departed L
NC DISTRIBUTION CENTER-
ErTue Aug 012017 - CHARL
August 19:39 pm ArrivedGRW-QWg %a &igin
CHARLOTTE NC DISTRIBUTION CENTER - In trai
Tue Aug 012017 - CHAR OOLaIWOM41 IM
9407 i 000 0000 0000 0(
August 14:37 pm Departed Post Office in SHALLC
transit EA 000 000 000 US
Tue Aug 012017- SHALLMMI be 0000 0000 01
Fl

Notice Left (No Authorized Recipient Available)
WINSTON SALEM, NC 27106
Out for Delivery
Sorting Complete
Arrived at Unit
Departed USPS Regional Facility
Arrived at USPS Regional Facility
WINSTON SALEM, NC 27106
WINSTON SALEM, NC 27106
WINSTON SALEM, NC 27106
GREENSBORO NC DISTRIBUTION CENTER
GREENSBORO NC DISTRIBUTION CENTER
n Departed USPS Regional Facility CHARLOTTE NC DISTRIBUTION CENTER
1
Arrived at USPS Regional Origin Facility
Departed Post Office
USPS in possession of item
CHARLOTTE NC DISTRIBUTION CENTER
SHALLOTTE, NC 28470
SHALLOTTE, NC 28470
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