76452D - Youndt

�CAMA / ❑ DREDGE & FILL N9 76452 A B
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
Prized by the State of North Carolina, Department of Environmental Quality ,,
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Q1``R
r \' I El Rules attached.
it Name C-)✓uk(I ) pld0 A4L Project Location: County '? V(' t"
1 V-' Street Address/ State Road/ Lot #(s)
,4y\p? Ce A State ZIP ;LN Q S
I( )
E-Mail
i:ed Agent JoS 0 (204 r 6t v
❑CW 1 (EW >(!PTA
❑ OEA ❑ HHF Cl IH
❑ PWS:
yes nT PNA ®/ no
Subdi`�ision
city 1� 6� KA r 5 ZIP L4-44
❑ ES ❑ PTS Phone # ( ) River BasiA� 1�4
❑UBA El N/A Adi. Wtr. Body�0oSa to SOOY (Cat
Closest Maj. Wtr. Body_, A
f Project/ Activity C • i ► Iu ..
a •
ock) length
MEN
ingth
ember
Ld/ Riprap 14
g distance
ax distance
hannel
bic yards
np
Boatli I 3'� 13 �
lulldozin
ie Length
not sure yes no
rium: n/a yes no
yes o
Attached: (vZ no_
ing permit may be required by: ❑ See note on back regarding River Basin r
Local Planning lurisdiction)

pu-103
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M-40

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTtFtCATIONIWAINER FORM
Name of Property owner:
Address of Property: -43 ( g tp v ` -i U H C
(Lot or Street b, Street or Road. City d
I hereby certify that I arm property adjacent to the above referenoad property. The individual
apptong for this permit has described to me as shown on the attadW draWIrtQ,,ths davNCp M t
they are prapo5ing. (Mmensiom must M mudded Yllijl 00 MOK,
/ r hhave no objections to this propoul. I have objections to this pmpouL
If you have objections to what is being proPos+4 you must noft the Dhfsfan of CassWiftWament
MCA9 in wrftng wfthin 10 days of receipt of this notics Conger 1pbrnatlon for DIM *Mces is
avidrrbialrt a taimanaaemaninaelydlg•eaVing !-bbb•pICQAS T.
M10 MSPO M k oawidM rlrs sama as no obrclioo N you ham bwt M WWsd by Ca~ Mrr!
WAVER SECTION
understand that a pier, dock, mooring piongs, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 16 tours my area of riparian access unfess waived by me. (If
you wish to waive the setback, you must Initial the appropriate blank below.)
ON_ I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement.
M"-051
(Rt xMm Property 0wir4WJW& matlon)

DVVWON OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICAT*tMAIVER FORM
Name of Property Owner. _
Address of Property: -43,
0
(Lot or Street e, Strneet or Roed. City &
s
1
.: a . •�� r. • w to
I hereby certify that i own property adjacent to the above referenced property. The individual
applyhg for this permit has described to me as shown on the attached drawri%Lthe development
they are proposing. A descri0on or drawino with d mensions. must be provided with this-Z— letter.
I have no objections to this proposal. I have objections to this proposal•
d you haw olyectlons to what is bed prgposad you mmf > d* 0MW*n of Cweief Mkt
(DCAChr wrhkg w hin fO days of receript of this nodes. Condd k*VMadoa bi OM *MOM is
av&gableat hrOlAwww.ncco&shWns raa*mwi .noyWvhVcn✓sra}% orbycaftw 14804RCOAST.
mo nepomw is oonslrWW the scene as no obdecftn # you haw b"n notlMNd by Cw~ lib&
WAIVER SECTION
I understand that a pier, dock, mooring pf&ngs, boat rarnp, breakwater, boathouse, or lift 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 biar* below.)
G I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
1
(Ripartan Property Owner Information)
✓ � �acstlL-�
Signaft"
0. 4 &N (� N�NIkON S
Prent or Type htsrrre
i
j�A Ra4 � It
14&ngGA ad W1 V44�2

Name of Property Owner Requesting Permit:
MaWng Address: 431
Phone Number- ,Vo - 3 q a
Email Address: s1'�Vn j ff)(jo hot fj&A
I certify that I have authorized —�sv' -bit-ber
agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits Q p
necessary for the following proposed development: ,, Yr t N� �� _ %"D 6�A
at my property located at 0481 1 62l ' S
in 7�eO aeQ County_
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information: