69376D - Odom

�CAMA / 7 DREDGE & FILL
3 E N E RAL PERMIT Previous permit #
Jew ❑'Modification ❑Complete Reissue 7—Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources U� 0 � } O O
-oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC d
n ❑ Rules attached.
t Name �(�(aca o do VO Project Location: County kjl"on _ on ( =
,( YO(A ( e- State NLZIP 2 9 Da
ail
ed Agent )L Vi 0 ('*:Nq 1
❑ CW )(ITA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ USA ❑ N/A
❑ PWS:
yes / 0 PNA yes / 76�
Activity
rko nr
ck)length
atform(s)
Platform(s)k 1(
ngth
-nber
J/ Riprap length
distance offshor¢
x distance offshpre
iannel -
Ac yards
'p
se/ Bo�Iift
dozing
Length
not sure yes
Street Address/ State Road/ Lot #(s)
�1:7 Q1( hvAA 6.0
Subdivision 1
City (,i -0 IS K -YU(_ �A ZIP
tK% # AW-34-4;1-1-799River Basin LAjWI�
Adj. Wtr. Body Ccf.0O- (nat
Closest Maj. Wtr. Body ,r l j,'J W_
ium: n/a yes (Op' i
— _ _
yes no
atached: yes I
j
ig permit may be required by: T—O ,4n b r Q �Q AV1 �S k t
_ocal Planning Jurisdiction) i ,
(Scale:
❑ See note on back regarding River Basin rL

k_IVV Jtmi� C�UIVuYVl1,f�
ADJACENT RIPARIAN PROPERTY OWNER STAUMBNT
(POR A PI�R/Ml1'tR]NC 1'XZINt^rS%BOAT�;,�j�fBOA'IHDUSIS'j
I hereby certify that I own pr()purty a,i.lacent to
(Name of i'roper!v Owner)
c
property locsted at L-
(Lot, lock, Road, etc.)
on in 1/L Si r. A Kc.
(Town and/or County)
Applicant's phone %la� titling Address: Iicio . Cnic
He has described to Inc, as shown below, tht development he is proposing at that 10c,atiott, and, I
have no objections to his proposal. I understand that a pidr/mooring pilings / boatilft / boathous'c
must be lint back a minimum distance of flfteeli feet (15,) hom my a, -ea of riparian access unless .
waived by me. (If you wish to waive the setback, you ,nest initiwl the appropriate blank
below.)
Lml VAS11 to Waive
�q wish to waive that seetbaek roquirement.
`DESCPJ.PTION.ANWOR D AMUG�Op t'Oi%§gD D.1CVfcL0PM8Nx: -
(To be filled In by lndivldual pmposhrg developmc,r,l)
---- ........ . ...... ........-----......••---_..._._..........._.._............___.,.- ----- ..........
(Informa(ion for Property Owner Applying (Riparlan iPr9orty Owner information)
for Permit)

AND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/1t100RING PILINGSBDATLIFTBOATHOUSE)
I hereby certify that I own property adjacent �-�� , Vaw-ca.�SgN 's
(Name -of Property Owner)
property located at __T__ l
( ot, Block, Road, etc.)
on ' , m
ems- , N.C.
' (Waterbody) (Town and/or County)
ailing Address
Applicant's phone#: M
n , _ - // -"' Ao,. 1-G A le-2
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 (I Y) 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
do wish to waive that setback requirement.
------------------------------------------------------......----------
- .
DESCRIPTION AND/OR DRAWING OF PROPbSI D DE'VET;OPM NT:
(To be filled in by individual proposing develo/p�ment) �p
-------------------- -
(Information for Property Owner Applying (Riparian Property Owner Informationj�
for Permit)
Aso . 63ox
Signature
Mailing Address
Z

125 NORTH FOURTH sTREF..T
PO 130X 159
ALBGMARLE NC 28002-0159
Telephone: [phone]
Facsimile: [phone]
Confidential
RoBERT W. oDoK P.A.
To: Gene Duckworth
From: Robert Odom
Re:
Fax: [phone]
Date: 8/25/17
Pages: _2_ (including coversheet)
❑ Urgent For Review Q Please Comment ❑ Please Reply ❑ Please Recycle
Please call to verify you received this fax.
Sincerely,
Robert W. Odom

CGE
L Mmme of Property O wwr Apply" fix Permit
Merry add(ess: � _ '
,0
oertfy that f harm autltxtwd
A�rtS! Co.rai.�Eo. "
b act on my bets, br tie pugme, of applying and obb" a1 GAMA petmds
neoes-wy fbrtf* KWo®ed development of 4 izj A-<,
at my PmVerty located R ♦
Cowt
This ceffacatbn rs valid tvough
ogle
(Properly OW:wr Moewnatiom)
Siyr�&N.ee
Li v�
rn" Print or irpe Aw"we
Date
�1
ee
cAW, N 4-
C Emit A&tws �—
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