53963D - Ezzell

CAMA / ❑ DREDGE & FILL
3ENERAL PERMIT Previous permit#
(New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC"}
❑ Rules attached
itName e A R L P— %y
meµ, t ( State ZIP_2.?454
c (nip Fax # (
and Agent
❑ CW ❑ EW 'PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
/ PNA / C 't H b /
Project Location: County
Street Address/ State Road/ Lot #(s)
Subdivision
City csc >� 4 j�lO 1 �t't' ZIP
Phone # ( .� 231.4S- River Basin
Adj. Wtr. Body N ,C. (' � }-:EAj4 na /
yes no yes r� . a yes no Closest Maj. Wtr. Bodyi��'�`'
F Project/ Activity F Xj' 4 i t'; _Kft 4j'A � {C t-. C i s r t1c% ti 11 NC,
-�-cknt,u 121, C. (Scale:
ock) length
r
'(s)1 X 12 4 r�i .. . 1, _ Imo- r t -- -- rt—
:ngth
amber
id/ Riprap length
g distance offshore
ax distance offshore
hannel
bic yards
np
ise/ Boatlift
lulldozing
ie Length'
not sure yes
, not sure yes
rium: n/a yes
yes [ -
Attached: yes no,,
7i
ing permit maybe required by: i'�� e (� Co. PG�•(�Y ��
❑ See note on back regarding River Basin r

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to
property located at
(Name of Property Owner)
S
(Lot, Block, Road, etc.)
on in f-,, d t'� , N.C.
(Waterbody) f (Town and/or County)
Applicant's phone #: 910 231.- 45S1 Mailing Address: `w �5 OU fqmke-1*LI
Y" 4 9.� 14, Tom' z-J
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 (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 not wish to waive
I do wish to waive that setback requirement.
------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
�,X,or,Signature
---� r 1 /f .A A

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to (24y L Q1 v-e vS -�-- 7Z e-[. f s
(Name of Property Owner)
property located at 40u--\,
(Lot, Block, Road, etc.)
on (A—P�- r^efi&,7 , in
(Waterbody)
?�-►vs2 r , N.C.
(Town and/or County)
Applicant's phone #:C(1l8Z31-4S31 Mailing Address:1 M��`�i
tf'�PQ�I Q JA r I�C iS 1q7:S4
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 (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
Signature
r 1

GWEN S. EZZELL OR
CARL R. EZZELL, JR. �f
908 OLD MAPLE HILL RD. 910-259-5207
MAPLE HILL, NC 28454 Date
66-19/530 NC
6090
Bank of America
ACH R/T 053000196
Memo (2 53 63 CPe
i:053000 L961: 0006093 2866 L11' 2 206
Carl Rivers Ezzell 3076
Rt 1 Box 1-A
Maple Hill, NC 28454 66-7693/2531
17-14(
Date
Pay to the
Order of_
Dollars
WWUP.0. Box 27306
CooHRA1wCREaruN'oN Raleigh, 23 27611
(� 2 91r9-87�2-2395
Fore 1' 53gb J ( �� _ P*
1:2531769301: 4350700003110 3076
C LIBERTY