68563D - Moretha

`LAMA / DREDGE & FILL
aENERAL PERMIT
(New `,Modification_]Complete Reissue
` A,tI 5�5
❑ Partial Reissue
`6563 A B
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 (5 a
❑ Rules attached.
:Name M <? �' 0Yl ��v\ 0A !C Project Location: County &,/1M(-tAA C K
(� SC 1Y _ Ca VV Street Address/ State Road/ Lo #(s)
>� V State ZIP Z Rqb (11
d 0 'AU --)I $4-`Mail
, IM0C'Q�16\ •(O+-4ubdivision C 0� r­t LC
W Agent 0i bin 1�( �t/1 City_ C� n ZIP!
❑ CW EW $1H
TA❑ ES ❑ PTS Phone # ( ) pgo " )-��y l er Basin-- 00EA ❑HHF ❑ UBA ❑ N/A Adj. Wtr. Body �10(nat
❑ PWS:
.Pq //Rn-) PNA VAC Closest Maj. Wtr. Body LA) [A
Project/ Activity
Length bo
not sure yes o
im: n/a yes
yes 1 n
coached: /Q \ no
g permit may be required by:
ocal Planning jurisdiction)
❑ See note on back regarding River Basin

ADJACENT ad % PRaaP BU QIjlj)ER ,MTEMMI
I hereby cerilfy that I own property adjacent to ,, CS
(Name of ProoiM Ownw)
proparty located /
Loft, 61odc,Roometcj
N.C.
(tR9atDorbody) andfo r County)
The applicant has described to me, as shown below, the development proposed at the above
location.
Z 1 have no ob)actlon to this proposal.
I have objections to this pmpossl.
DESCMPMON AMOR 19RAVVING OF MOPOSM ®EVELOPMB G
fir
altee0 Fos&rig t nMst fit/ fae ' do
o tto daG-e
below a' affach a
13�k�ct3 G}
.9 -V
at C,
Ln " 5
1111D d0a, 15
P L. WAM SEA PL
I understand that a pier, dock, mooring pilings, boat ramp, breaWatar, boathouse, lift, or groin
must be sat beck a minimum distance of 15' from my area of dpeftn accass unless waived by
me. (If You WM to waive the se eck you mast Initial the appropriate blank below.)
A I do wish to waive the V setback requirement. Jrr 40 ft s a .• +� � ¢ �"'•�`✓
9 do not wish to waive the I V seffiack requirement. .
(Property Cater 9nJornaM9n) (AOwent Property r IntamuMon)
Adi9,*a
u
e

I hereby certify that t own property adjacent to �Jyg-'4�- a -i�%'�tsas� lac -1
(wame of Property Owner)
property locatedai� _/4 jp%,} /44,7_;? 4.4 12e. (;1 AiA 1
(AtWriss, Lot, !!!dock, Roe
Seta d�f) (hy owm and/or County)
The applicant has described to me, as shown below, the development proposed at the abo%.
loca
Je i have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION 6NDIOR DRAWING OF PROPOSED DEVELOPUM
�InaF dear® praposira� nua;f >3N hi tie starfjoiio �o/oa�r► or� aft*'*
a a�
x I 09 d 13`�X13cN
b
�y
� o
en 'S
i1 x2o'doc�.
t'o b � oh
15Ft
PL `
lllfAM BECT12N P L
i understand that a pier, dock, mooring pilings, boat ramp, breatkwater, boathouse, tilt, or groii
must be set back a minimum distance of 15' from my area of riparian access unless waived b,
me. ( M,7 wish to waive the setback, you must inMet the appropriate blank below.)
do wish to waive the 1 V setback requirement, $ o a _ L_ t jrl,- = ®15 e o .. +,,, . Q
i do not wlah to waive the 15' setback requirement.
(Property Owner lnfbrmadon) (Adja nt Property Owner inforrnadon)
gna rt gn t PiI' ((
k A, A✓ A&' s •V'
nt or Type�N e Print or T e Name
�" �ngLAddr� .
Mel �Address

'A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
erly Eaves Perdue Braxton C. Davis
rernor Director
AGENT AUTHORIZATION FORM
Date:
s of Property Owner Applying for Permit:
a ea -a 4,Z-A, a� Rd.
;r's Mailing Address:
s Number ('YZLS' 0- 2-86
Dee Freeman
Secretary
Name of Authorized Agent for this project:
Agent's Mailing Address:
2798 Sea Vista Dr.
— Hg= Supply, NC 28462
C9NSTRUCTIBN
Phone Number (� [6)
fy that I have authorized the agent listed above to act on my behalf, for the purpose of applying
d obtaining all CAMA Permits necessary to install or construct the following (activity):
0,CCC-S
iy property located at ii , 0 :L IL PIA fq- 3
ertification is valid thru (date)
Property Owner Signature Date

51
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