69108D - Purser

AAMA / ❑ DREDGE & FILL j I �Vr It by A B
iEN ERAL PERMIT Previous permit #
New ❑Modification [I Complete Reissue ❑Partial Reissue Date previous permit issued
died by the State of North Carolina, Department of Environment and Natural Resources 0
'oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Name:bq, �' t V �'� Project Location: County
Street Address/ State Road/ Lot #(s)
State ZIP
E-Mail ` Subdivion
ed Agent City_
' L ZIP
❑ CW W A ❑ ES �[]N/A
Phone # ( ) 1 n ' River Basin' ��
❑ OEA ❑ HHF IH ❑ UBA Adj. Wtr. Body Y V (nat
❑ PWS:
--� Closest Maj. AV. Body
yes ro )) PN yes no
f Project/ Activity `% 1-, � 1110
,ck) length_
atform(s) J
Platform(s)
imbe
+tuber
id/ Riprap length_
g distance offshore_
ax distance offshore
hannel
jbic yards
Bulldozing
ne Length
not sure
)rium: i
Attached:
1
(Scale: 1 '-/
ling permit may be required by:
❑ See note on back regarding River Basin
i ` h

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to T-n\J l U P.�-ky- 's
property located at �p �`�� C Q a(Namof ie ,�o , Owner)
\'
(Address, Lot, Block, Road, etc)
on ihJW , in oir \11ar , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
( operty Owner Information)
U'-1' J C, /-I-- -
Sinnature
\AA �, urse�
Pent or T pe Name
w-'tl ea'o- ocl Y-- ISiG�t� 1J ✓
Nailing Address
Prop.f" Owner Information)
Print or Ty e Name
12�o�i Ja ca 'J m n A
MpWng Agdrg$s T�

WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 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.)
_ f do wish to waive the 15' setback requirement. �3 JL4+G✓
I do not wish to waive the 15' setback requirement.
(Property O nor Information) (Adjacent Property Owner Information)
Sim nrre Signature"
NO.,. d w�a S;4-r't'-r &"S:
Print or Type Name Print or Type Name
t;'ool o'4�.�., W.11 uMfs- YBre1 ' . c9'ftk &1'M&J lae
Mai ^.-1. Act ress� /�•+✓ s / Mailing Addres&JO J /1AC ZP`5;
city, t ip a4vstate/Zip
1/0 - 261 - w: --
Telephone Number / email address Telephone Number / email address
Dare Dale •
(Revised Aug. 2014)
I Y,-tUd for one calendar year after signature

4d
1,608 E Yacht Dr-
F Yacht Dr

11 /1 /2017
Jerry Mills Contruction Inc
William Kelley
11 /112017 _
Backwater Marine Construction
Rodney G. Smi
11/1/2017
11/112017
WU Money Order from John West
Kathryn Langford & Thurman Binkley
Rick Whitaker
4Ka_ thr�n Langfc
11/1/2017
F and S Marine Contractors
Richard Fisher
1873
68572D
68567D reissue of 69319D