69130D - Newton

�CAMA / ❑ DREDGE & FILL 2 ��
3ENERAL PERMIT Previous permit# A B
At4ew Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
sized by the State of North Carolina, Department of Environment and Natural Resources �`� f
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ( i 1
❑ Rules attached.
it Name c aN (/W ► 01yj Project Location: CountyS�
Ir 0 Tr a, More{ Street Address/ State Road/ Lot #(s) `
�'"^ n
Yt State ZIP (�, ` Gt 1 I (!►S� S� ,
t ) l E-Mail Subdivision
:ed Agent N G C b he'- �-"vCD .1 Ci C ZIP__
❑ Cw KPTA ❑ ES ❑ PTS Phone # ( ( ) Q 90—H 3— 91 River Basin
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body ra VAl (nat /
❑ PWS: , ,, /
yes / io PNA yes / no Closest Maj. Wtr. Body � w✓y
F Project/ Activity 10
Eck) length /
atform(s)
Platform(s) Ix_I
!ngth
tuber
d/ Riprap length
g distance offshor
ix distance offs re
cannel
"c yards
np
ise/ atlift
loom
■■■MEMO■ QAWMMMMMMi
MMEMM■■M■■■■■M■■MI
❑ See note on back regarding River Basin r
r

North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis
Governor Director
AGENT AUTHORIZATION FORM
Date: 3 (?-
Narne of Property Owner Applying for Permit: Name of Authorized Agent for this pro)(
161-1- 5 k k N�`W&V
Owner's Malting Address:
Phone Number 119) 7( 7 -- Cl1
Agent's Malling Address:
2798 Sea Vista Dr.
RHIS
e Supply. NC 28462
Phone Number (ql d) no -- �3 � I
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of appiyi
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at
This certification is valid thru (date)
Property Owner sttnaotara Date

l hereby certify that f own property adjacent to
property located at _ lr_LA
i�� (' (Addr��s, tot,
on 4� ,
(Wah"body)
ER4 rc�+T
L j
Name of PNam P
N.
(Cttyfl'" and/or County)
The applicant has described to me, as shown below, the
locatiory
t/ t have no objection to this proposal.
! have objections to this proposal.
proposed at the ab
DESCRIPTM ANDIOR DRAIMNO OF PROPOSED I EKELOPMENT
(IndhdWof prgmsk g devekpment must NO In description befc4v or MwA a site dnnW
WANER SECT) M►
1 understand that a pier, dock, mooring pilings, boat ramp, brew
must be set back a minimum distance of 16 from my area of dl
me. (If you wish to waive the setback, you must initial the appm
,.1 do wish to waive the 1 V setback requirement
i do not wish to waive the I & setback requirement.
,, boathouse, lift, or g
access unless waived
blank below.)
(AdUacent Prop Owner lnfarmatton
S: tur
Prinf or T N n
�b 5 t41��b:l
nng A
�-­' D A.�' AIC 2 � 1 `L
C►ty/s�ata/Tjp '• 1 t. f C C
2 o CI - i 3gi 2,. - i t
A A TaJanhnna hlr&-YAArl amatl a4dramv

I hereby certify that i own property adjacent to �(Aiame of Pi.property__ .�...
property mCated at "f � � ,Ai l�
on (Address, Lot. Block Road o
(Wfaterbody) (Clty/TOWN
The applicant has described to me, as shown below, the developr
location.
1 have no objection to this proposai.
i have of jedons to this proposal.
De*M1P'T10% MDftl'k D ViNG OAF PRWOMD L
Mc>yvMml WgD=kV d wWopm W must W in descitWon belt
andior County)
proposed at the
or attach a she dry
wAlslEcrl�l
l understand that a pier, dock, mooting pilings, boat ramp, breakw 3ter, boathouse, lift, a
must be set back a minimum distance of 15' from my area of ripar an access unless wai
me. (If you wish to waive the setback, you must initial the appropr1i de blank below.)
l do wish to waive the 16 setback requirement
i do not wish to waive the IS setback requirement.
(Ad*mt Pro arty turner lnfcamst
Signatur y'
t
Perot or TypPj