69271D - Jamison

DAMA / DREDGE & FILL
3ENERAL PERMIT ` Previous permit # A B l
New ---!Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
irized by the State of North Carolina, Department of Environment and Natural Resources
coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC U 7 # - / ZC�D
❑ Rules attached.
it Names y-��� / / ��i/" '� �� l�/ /� Project Location: County 1E N /✓rJC -
�c�7jell ', / Street Address/ State Road/ Lot #(s)
State A16 ZIPZ� L t� CTo V w III/
7Ar—MaiI Subdivision
tedAgent j /yiA-A,) City
❑ CW)CIM �kTTA ❑ ES ❑ PTS Phone # River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body t"*A'�4L5rG
❑ PWS:
,
yesC� � PNA yes® Closest Maj. Wtr. Body ,/D¢�L SO��.✓G
F Project/ Activity
ck)length
atform(s)
d/ Ripra ength
distance owIlzore
a distance offsh
cannel
sic yards
1p
soao2m':1 / Z fC/Z
ill ing
Length
not sure yes no 1
um: n/a yes no
yyeesc� no
ktached: v/ ec 1, no
(Scale: /
L
ig permit may be required by: (qQQ�- V ❑ See note on back regarding River Basin
_ocal Planning Jurisdiction)

A
DENR
NC
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dfee Freeman, Secretary
'
Beverly Eaves Perdue, Governor James H. Gregsort, ►ctor fe
Date
1
Name of Property Owner Applying for Permit:
5coll ' J'e--'Am) 'AMISU1")
Mailing Address:
4 fie► 6; 1� c- 2 'Ac 1
I certify that I have authorized (agent) IJ A I_ r-b Ger L wt A A) to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) R&=`'c_1t 1"
tom+ F'T" � � u l LD c?� c K_ �` � ►-,L � � r r � _ r � c �
at (my property located at)
This certification is valid thru (date)
Date

_ ' ::;:«s, ;, ' ac :i. x`.: � �• .- - � . L!dli�lt itillf l�J L c.0 •�J -+ ta--i ttlsY .i f
."'•`t >X' C.t ,...t'"" :.! i±irn+nl 7n� 44'St r - {:> ti"1 trttr-'{ +nT• fin,,• tsr riil:ir-ir.:r-i'f ; F n -
mov
.�_..- _- �. .G+ .. •. .. _. . Y . - A Si\Si 4 }i,fJ 'RJ t.. T i.i )a .' R♦ . s
uc piled tit tq Ailaivlauai In upusing tieveltspiiiem"
y. a�..,7 A11JS Yr}nLTT1k'Ti Djt_'. ./�}+,(^
skkk�lt!lattiei.4., i'Ytt�Fcii4vwflYl iOpl.,In! SK!i)ari:f s*rf)n m,tlwnerlt,;grmatinp)
ti f
►L ittc iL.

I
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORING PILINGSiBOATLIFT'BOATHOt/SE)
I hereby certify that I own property adjacent to =* , , %! 3 +M ►So ►J 'S
(Name of Property Owner)
property located at _l Z(o&ODW (o AV-6 Ta PS4I t _
(Lot, Block, Road, etc.)
on 3"Ics C tta:v4c.' . in __irasr,;t_Fi +l 1 _P D 1Z , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 9 L9 ?Ro-a"l7S Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
----------------------- ----------- ----- --------------------------- - - ----------- --- ------------- -----
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
tawcA`TIoN OV SoAr- LAPT #ZeSUit-V OF'
C-AtSTr K6►- 8 x 20 pock. , A ivo ADD,-rroN 007 Sx Z4
FtO A.T I nL6r 7JoGK A 4)C Z0 1=f M 6-ea Pry
---------------------------------------------------------------- --------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address ignature

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