54415D - Thompson

❑LAMA/ ` 'DREDGE & FILL f'
GENERAL PERMIT Previous permit#
❑iNew _IModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina,Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
h / - I I V U
C�RUIes attached.
nt Name �`h{ p/}Fe f{ C T}tp( i Project Location: County Siet-VVJAMC.f .
ss III-/ K i N6Swm/) 0 t . Street Address/State Road/Lot#(s)
ak&IAJ State NC-ZIP Z ?Z`/ /O L i(j 11Z !kAi-i z , + : 1,.).
#091[2) 8q 2-4 cli Z'Fax#( ) Subdivision
ol ki1-g"at�O(o
ized Agent Alla'IC fix) FISH (0 - - rr Sr ttlqf'o2�'. City •SC'LrThc7ier ZIP 2j4
d ElCW ❑EW C PTA PFS 'ES PTS Phone# ( ) River Basin
L1 OEA ❑HHF ❑IH C UBA ❑N/A
is PWS: ❑FC. Adj.Wtr. Body OttlE Cl re
yes / PNA yes / t'io Crit.Hab. yes / no Closest Maj.Wtr. Body ,
of Project/Activity r.1jI
(Scale: I a-=
dock)length
I
rm(s)
::
•piers) �• 111I
,�111 � MI .7 " m n mI, I1
mm�naisii
length ••® LVr./ aiil L f�rElMUU•I � • MI
lumber w l 1 IIIIIIHHHHU1_ , IHHHUHhI
�� f J
ead/ iprap length n - :'"% 'r1 i �� iQ'�' a ;.• r r I,avg distance offshore D Al ti;1_ / 0 e'° . Arax distance offshore 5' �
channel i j
���� •� • •��1� 1
:ubic yards HHIUIIIHUIIHHI
■■amp --- .. — II_
ouse/Boatlift 4
Bulldozing t r,, ; !1Hhl.
. , .....
4
igii . ,, iirpci
line Length IsN xiu?; «r a° a!SRii 70i agi l.: �llii fill iAl
not sure yes ho FJ11
ags: not sure yes no' 4 P , ill j
orium: n/a yes no' Ili- `e — I9
s: yes noi I :Pill 1.'---4-1
6-trtt S
r Attached: yes ,io I I JLW
ding permit may be required by: O ntPO,'r I See note on back regarding River Basin
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
•
I hereby certify that I own property adjacent to lt.nd. ari ,//len�$4r/yu..'s
(Name of Property Owner)
property located at /6 Q R!vu^ lit v / 2
-� (Lot,Block,Road,etc.)
on f tear' /2i Utr ,in ,
(Waterbody) (TTow'n and/or County)
Applicant's phone#/9/6) Y92 /9/Z Mailing Address: lf� /V� ,Sar�.y ride.'
AA, N. C . a/33
He has described to me,as shown below,the development he is proposing at that location,and,I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
,e?,/./-ixi,
Mailing Address 11 Signature
S�r►err; `n etyWQ (
e/'!4+-k Ie "14)eive 11
City/State/Zip Print or Type Name
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to—Pen.. au P iC.e- //lemo�oriru .'s
(Name of Property Owner)
property located at 16 IC/ver Lor./h Lzt.tr 2/
(Lot,Block,Road,etc.)
on rf ical JQ/dtr ,in ,N.C.
(Waterbody) (TTowSi and/or County)
Applicant's phone#0io) Y92`}/Z Mailing Address: l/4/ A ar&y c,�t/d e�
N. C. 0a33
He has described to me,as shown below,the development he is proposing at that location,and,I
have no objections to his proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
cCG 144 -ink . . .
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature
FA.44M-K- tot,fic
City/State/Zip 5.4 Pri t,gyType Name
111'144 .53� . 9.-
Telephone Number Telephone Number

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Ati A
North Carolina Department of.Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James Ii.Gregson Dee Free
Governor Director Secn
AGENT AUTHORIZATION FORM
Date: /a1/b' D g
Name of Property Owner Applying for Permit:
Mailing Address:
1114 r ve_.,
ItkNAJ1 ag3 q
Phone Number: (II D) g`I.• /
I certify that I have authorized (agent) / D Ivl Ivt U e-!"r y to act on my
behalf, for the purpose of applying for and obtaining(all CAMA Permits necessary to install or
construct(activity) 1k c k W a 1
at(my property located at) 0 2. t LeLA�e.. S o k p e pi,
This certification is valid thru (date)
41)(rte..i.C-.7 1- .... /z//s,Jo 9
Prooertv Owner Signature Date

7770
66-301531
254
Son DC 3347899
N. Thompson DC 329986t5 L I I 0� DATE
8334.Thompson 1912 0
892-
WayDr 91� $ ��
28334 pp,, F..,„,,
OLIARS
AA � N" resent.do not cash.
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l/gra r and linework.First Citizens Bank logo
�ok lire.Micro Print signature line,$r�type ,
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stcitlze CU1Q-' 'll• �? � �� s
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