76421D - Eichorn

1CAMA / ❑ DREDGE & FILL N9 76421 q B
3"ENERAL PERMIT Previous permit # .�
New Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environmental Quality :oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 7u
I r ,* '
(� G El Rules attached.
t Name , Q E i h yr P� F� I �U 6ee Project Location: County Be � n $w I
ianSb✓� D Street Address/ State Road/ Lot #(s) 301
Le, ctY\ State N L ZIP 99'q SI �"n � � LfP,4, SF
` (q)0) 7o VD E-Mail e O "✓1 Subdivision1000.
,ed Agent N)L P�USO►^ MONIV\PIc (of-
-, City f V A ZIP
❑ CW KEW X PTA ❑ ES ❑ PTS Phone # ( ) River Basin Lu iM6
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA Adj. Wtr. Body 14MbJ
ElPWS:
yes / (S PNA yes / Closest Maj. Wtr. Body

Nip 76,421 A 6 CO
QjF�r;E:RZMILw prqvwlA Parma
pamll PAUAM Dat pvvvA pernv suAed-=_
Agaijo-ow bytse Soft Qjp4wd
Apolum Nw* vr—
haprct Lftaw Ceaw4 Mtn Kiwi- f
Cay CIAW+j SOW&_( )Pq $;I e_ ZV
phaft I b jcao. n 3 1
&OW-OdApm KPMA50- MOVInt, Cky9 Z v 'k zip
AROCted CW XIW X FFA as M fMipac M j itwr smog cx
AFC(sl OCA "Mr 04 U" WA A.* Wa_ 8.4 Aj jpw% ,U*M
PWS u MM.WtF. Body
Oftw P14A cl"O
Type Of Project Activity
JL
(.Atj, ift flll
r.k"ftwh"sf j4,q,#,j
F-W Omwo,
—Ali
CAM
tom
on 0 1
as dit
as JAN W
CUbK �Jtdt
6— ­0 , I i
5%9%*UW
• SAV fold S" I-
610
Wama Aft*Owd
A buddrl p-4 -W be "w
i Noo LOCW Ptaw I OU&MM
MGM* %WCW CWA*d@ft
too"
$a am an but fqprdft how Sup r A c
jn�

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:-b ►'� A-. i► Gb"� �✓l� S��C�rr.bG
Mailing Address: �CJF.,� gQ,�Q�<--�
L.eA ar-NJ 11 c- 2 S Lf51
Phone Number: `�)` 10 14-70 .3 3tD3
Email Address: d e.l cht7,,,n V4 9)1 cloud . co✓v-%
I certify that I have authorized i i C C r u�� hw►'ZQ. i. v KGc' , L L G ,
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development _ �� Q-1 jQ y 1hp
WC- .; vr. Ct15ki
at nay property located at - fo I H
inl/1flE[ }L County.
I furthemoro certify that I am authorized to ,grant, and do in fact grant pemission to
Division of Coastal Managonient staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
pemtit application
a,,., j t ;-5+.-, L I
dvcyc .
Property Owner Information:
vy "" & CdWVk
_E4L 0LCjM)W _,_ 'N-)Y) A "
Signature
Print or Type Name
pOi� `�✓ EI si .e_ � U m �_
Ti*

CERTIFIED MAIL - R TURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property (?caner Mole C-'�
Address of Property. L- �v t 3 1 l L-C":pt� F614 Q d
(Loots or Street#, Street cy Road, City & County)
Agent's NameA:. �a" r 1C�_ Mailing Address �.�'fit'c Nit,
Agent's phone # L110N�i3 511 a_ �' .�l��h
I hereby M14y that I own property adjacent to tree above refere, cea property. Tne individual
applying for thi-s permit has described to me as shown on the attached drawing_the development
they are p(oposing. A des 1>ipdron or drawing, vrtth dimensicns rrust be arovided wrth Ih�s letter
_ I havc no objections to This proposal_ __ i havc ollim:tions to this pmIu ail.
)f you have obycctlons to whet is boing proposed you must notify the Ofwsta" of Coastal Management ; OCM,, in
wnting wit4in to days of soaps of this notice. Correspondence should be mailed to f 21 Cardinal Lori; a Err
MIMIngtan, NC, 28405-3845. OCAf rapresent,twes can also be contacted at (910) 7W7215. No rosponse is
considered fhe same as no objection if you hate been notified by CoMfied Mail.
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, breakwater, boathouse, 0, or groin must be sei
back a minimum distance of 15' from my area of riparian access unless waived by me %If you
artsh to waive the setback, you must Initlal the appropriate blank below.)
100 wish to waive the t 5' setback requirement
_ __ , do not Nash to wa ve the 15' setback requirement
(Property Owner Information)
Signature
t.c��21�
6-0)(w Type lVanre
gC1 -7 zPC-, load "t!lY lPd
4taA4ng Ad&M
,� - /VC 9 Rq22
::rly/5tawkP
(Adjacent Property Owner Information)
Sig►rrNttre r
1 641 C-
Prin! or Type !mine
Madlrtg Address —
City/stawz)p` —

ADJACIFUT RIPARIAN PROPERTY QWNER STATEMENT
I hereby certify that I own propprty adjacent to _atb i _ ,Et L h D✓ Y-)
Property located at 3�`t LAXlcwaU:�14 Iu Name of Property Owner)
Lot-
on— 1t1VV, o,�-�,, {Add�eW Lot, ioc Road, etc.)
(watero«ty) -'�- - �ti
{CityfTown and/or County}
The applicant has described to me as shover. below, the development pioposec at the above Io:ator
I have no objection to this proposal
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing d0velopment must rill in description below or attach a site drawing)
WAlYER SECTION
understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back a
mimmum 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 Wank below.;
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requireneent.
(Property Owner Inf0anation) {Adjlactnt Property p rty Ownrtr Information}
!'
t or Type ��ame .t SS�,3 , C
n , PLO ,r A'a�nr8
WaAng dareSS ' i J
C-

E«hn

n Name
Nm ofPefmlt Holdw
Vendor
Check N—b.
Check
—f
Permit NumbenCommmh
Recsipt or Refund/RWOcated
mft
ColumM
Colutrer6
Columne
Cok-7
CoknmN
Column9
Gary Sam WJonathan Riley
886T
6563
$ 400.00
GP#76101D
JDrct.10196
In LLC
Simon and Adrienne Medley
Weis F
5491
200.00
GP 074858D
PA rct 10761
same
South State Bank
2483
S 200.00
GP s76527D
PA rcL 10764-
Mark and Carol Tabon
Fkst Gleans Banc
3155
S 200.00
GP i76197D
88 rcL 10473
:es LLC
Debra Eichorn PA Eleis Cumbee
FCB
3158
$ 200.00
GP IM21 D
Bbrink rcL 10441
Jim Jordan -
James Minen
Banc or America
_ 6190
3156
S 200.00
GPi75417D
Bbrink rct 10443
xs LLC
FCB
S 200.00
GP 4r16108D
Bbrink rct. 10442
Jan Peelle
I FCB----
i 890021
S 200.00
!GP#74653D
Bbri1