69418D - Sheppard

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CAMA / � DREDGE & FILL �ti�1' A B
'IENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources �' D
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached.
7
t NameProject Location: County�`�y. 1rcC�t-
a
,t, State ZIP Z�
j_`J(.3E-Mail
ed Agent LQNL%t 4le I 1,1
❑ CW ❑ EW ❑ PTA kES KPTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
drrN
yes /I no PNA yes
Street Address/ State Road/ Lot #(s)
t,A,V Q
Subdivision
City_ �" ZIP ---
Phone # ( ) River Basin L„�
Adj. Wtr. Body Ca ` (nat /I
Closest Maj. Wtr. Body 11 nA 1A
f Project/ Activity ju r J
e*-k S �'a !� VQ 1� `^r`tlr' (Scale:
)ck) length
latform(s)
Platform(s)
mgth
ember
s Riprap length
,g distance offshore
ax distance offshore 1%
:hannel /
ibic yards
mp
use/ Boat
Bulldozing
V,�V�
See note on back regarding River Basin
r �

�'a- WC;ory
.;Cver�pr
�ma-m�
North Carolina Department of Environment and Natural Resources
N C Diwsior of Coastal Management
FTM
AGENT AUTHORIZATION FORM
Date l `�I- ! i
Name of Property Owner Applying for Perml Name of Authorized Agent for this prc
Owner's Mall ng Addres
_/Yz ��Zs,r,2 ,f_
Z-/0-�a /vimgX11(o Z-
Email 71 Y4iL6v►%t �%/j'1� °
Pho^e
Agent's Malft Address:
Email dine L. &.7 G �•�
1 _ericfy that 1 have authorized the agent listed above to act on my behalf for the purpose of appl,
for and obtarnmg all CAMA Permits necessato install or construct the following (activity)
For my property located at /1/2— ,io -,LJ

I - PROPERTY
Name of Property pwmer
Addrew ofPropert,
DrnSWN OF COAnAL ,CIA
ADdACEt' RpggIA.W
O'ER STATP4ENT
(Lot of shva. Streti e1r
Apphc ants phut #_303
"` %04)WAY)
AJ e IA/1- -7
I
hereby i own per,
has dMCaCd is me as shown on �dra�g � YVPb%r is pe
pr°posing- A dean of dray
to this
MUPOW �e � to wig ---- I h+e ob,�«xioffi to this .
is aril IO � �°* �'�gst
days of raeipt sf t. g., % of Coast
� mpresentatmes� at
be �Ued ire 1" Card of Drive
as )wan►e �} 79+6-7�1 rie t is
I uDderstROd dw a pier; dexde, �'�R SECTION
151 i>um my area ofess bo�fiotrse, Or liftmnst be
VPMPri ft blank below.) artless by (if YOU WiA to waive the letbwk YOU 100st hai the
—=--=--a.__
I do wish to waive the IS' set back requirement
See, e ei 0> Q aW f N
_ I de trot wish to Waift the 15' set bunk
rnW a Type Name?"Hug Addrm
�oi'matiAe}
Print of
oe
c is t act VW,
Tie Nmmber

(.'LrItT RjEn AIL- RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
dwi
Name of Property Owner: l o F-' � 14,411. P. 1 1141 i J_
Address of Property.
Applicant's phone #:30�3
(Lot or Street #, Street or Road, Cit & County)
( uftSu
Mailing Address: Ca by'eJ9, t.S O (�
I hereby certify that I own property adjacent to the above referencedproperty.
has described to me as shown on the attached drawing the development thrcP ro posing individual applying for the
With dirnerlSiO must be provided wilt letter y Proposing. A description ofd
I
ii I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is beingproosed /
you
in writing within 10 days of receipt of this notivision
ce Correspondence shouMint nOtifY the ld be Coastalof Management
Wilmington, NC 28405-3$45marled to Cardinal. DCM representatives can also be contacted at (910) 796-72I5. No respons
considered the same as no ob'ection if You have been nntirim i--
WAIVER SECTION
I understand that a pier, dock) mooring pilings, breakwater, boathouse, or lift must be set back a minimum dista
15' from my area of riparian access unless waived by me. (if you wish to waive the setback, you must initial tl
appropriate blank below.)
I do wish to waive the 15' set back requ iremcnt. Se e, P Q a W I /U
I do not wish to waive the
15' set back requirement.
(Property Owner Information)
i
OUnture
Print or Type Name
Mailing Address
l,
G
„.� f
Co
try / State I Zip
Telephone Number
net. "/ le,
(Riparian Pro e�rty Owner In/formation)
Sig re
De�—e
Print or Type Name
//
Mailing Address
City / State / Zip
Telephone Number_33'6 69— - ���

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