68562D - Marshall

t:AMA / LA DREDGE & FILL �q��� P�8562 A B
iENERAL PERMIT ►� Previous permit#
New ❑Modification El Complete Reissue []Partial Reissue -Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources �OOU
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC . f f Rules attached.
Name_M\k3()V,1rt Project Location: County _&1 50h?
V1 I-) ( - Street Address/ State Road/ Lot #(s) f
Q d ii1 1 �. State ZI P715 q 1 _ fA V�L�I,�J A `�l (C ( 1 S
\ on {r %�ALOASubdivision
E-Mail "
Bd Agent (1Z —��� licit y OLth S� C �t At (y l ZIP
❑ CW �EW YP 1 A ❑ ES ❑ PTS hone # CTM) 3 /' River Basin ✓ OA
❑ OEA ElHHF ❑ I ❑ UBA ❑ N/A Adj. Wtr. Body CA V) (nat /1
❑ PWS:
Closest Maj. Wtr. Body Iw / 1- —
yes / pfd—) PNA yes r9
Project/ Activity �1 t ` �l }1�1— 0 R
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atform(s)
Platform(s)
ier(s)
ngth
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g distance ffshore_
ix distanc offshore
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(Scale: ) 11
❑ See note on back regarding River Basin

AGENT ALrrH T1O F R PERMIT APPLICATION
Name of Property Owner Requesting Permit �l
L�,SD-� ��ry41VISA4 L' -
Mailing Address: 2bo T Dk'"� 1Q�n h� -
�Odl�d AC Z-7916
Phone Number:
Email Address: o11(SehS%,� nnni % [�vtin --
1 certify that I have authorized-
Agent I Co *WtOr
to act on my behalf, for the purpose of applying for and obtaining all CAcMAA permits
necessary for the following proposed development: �7 4 `t —
at my property located at 1 1'� <'AvW-
in r County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Ofr"icer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
property Owner Intomwtion:
p Signature
-
Print or Type Name
1,QO&c cu. D Me
9 1 nJ 1-1 "<
Date

'-�fl✓-j2pr r (�)L1�
1 hereby �fY the 1 own property soment �.
located at
i �'-,•�S� t�A
y {/lddraas� f k emck. Road, N C.
on (Wat9erbody) (City/Town andla County)
The 9WHc A has described to M. as shown below, the (javelaPment proposed at tim above
1 have no objection to thts proposal f f� N
1 -have objections to tNs proposal•
t > oEBCMpTW ! jM DRAVMG of PROPOSED DEVELOPMENT
ink P►opookv t m0W IM lA dmeeslptlon bMoaor athoch a sMe drawkW
WAMW SECTIN
► understmnd that a pier, dock. mooring a+�, boaR fHQ P, breakw8ter, boathouse. W!. «9rd^
must be set back a mtr*rm m d�noe of 15' from MY area or," lart acoess unless waived by
me_ (tf wlah to waive the setback. YW morn irdtial the "Vmpriabe btardtc below.)
l do wish io wawa the 1S setback requirement )Lkids T—
XT' 1 do not wish to waive the 16 setback regvirwrtent. ft •J (�°�. r.
(AcBeoopsr11 Owner kd6nnalion)
addmw "/ aodh
abndmdAm 2014)

NT
64&�:�s
1 hereby certify the! I own WWwrtY ad)aoe1 to A lisv �� party Ownarj
property Ionbad et...L9 ����y►a� .fir• Cam-1,A..� �,A.,�•�a
�Addraaa, trot. Block Road. e�c.1
on
In X=7s
(Wterabody) (CityITlor own andCounW
The described to me, as shown below, the development Proposed at the above
I have no objection to this Proposal.
I have oNecd" to this Proposal E--
DESCRWTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(In WkkW proper dovekp-mW mu*t tV In dasa*Won bsloa oralbch a aXe droWno
S'EJE
WAIVER SECTION
I understand that a pier, dock. moorft Pith % boat ramp, breakwater, boathouse. foil. or groin
must be set back a minknum drstanoe of 15' from my area of riparian aooass unless waived by
me. r- waive the setback. you must initial the appropriabe blank below.)
do wish to waive the 15 setback requrement
I do not wish to waive the 15! setback requirement
u
arty (Ac,ao h Owner Intormatlon)
2-00� runr :bes-, 9,r Ito� 7 > ow
Mefting Addnse MaAip Address
tsynacJA lip NC 2'7 � ie �c.•.� T�1� &x AIC-
•� io%o q33 S j(Tt_
/ WrW address " coIN Tekp/roneltkrnber/er»�
Dwe • �'�
(Ravbed Aug. 2014)

October 9, 2017
■ Addresses — US Hwy Minor
Roads — NC Hwy Parcels
Interstate — State Road Condo
m.
44
1 0
Parcel Nct.) OU44 ) �T
0
Building Footprints /G) S .� j�•��lr,s�a9L�-- Brumwk`Cc