50380D - Wagner

la AMA/ ❑DREDGE & FILL
GENERAL PERMIT Previous permit#
C New ❑Modification ❑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 I 5A NCAC 7/�• .2 lJ 0O
l [+1•Ri les attached.
nt Name 7p,f9t✓� WAGNE/t Project Location: County RI/U"'swift('
s c 2 c/ 4rl p7,4 Aij (7. ,SC• Street Address/State Road/Lot#(s) s/9i'72 r
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',Z,v,? Stater/ C ZIP 2 k%z 2
#("U)t/2•y(e ' Fax#( ) Subdivision
ized Agent .Sfe1,,/4,, (f , c✓,-',• City ZIP
d ❑CW ElEW ❑PTA ❑ES ElPTS Phone# ( ) River Basin Z.ri m,
❑OEA ❑HHF ❑IH UBA ❑N/A Adj.Wtr. Body LOc/etvov/1 Ally /�,✓•'2 t
❑PWS: ❑FC: .
yes tno PNA ;des / no Crit.Hab. yes / no
Closest Maj.Wtr. Body /'/ r ,,k../
)f Project/Activity Re " 1
L,L ( f [.x 1( 1,,.S Pi? , t//f 7 e ,i 'eel.e 'eel.
(Scale: /
ock)length /.2 g ')< L/ ME_•
pier(s) • 1111111111111=M 11•11111_= '
length • —M•_____ ����_
umber • U. =PI NM Igi��®
■ UR____1!M MI��M'_��_
ad/Riprap length • —N_.■ `' INPI11111
vg distance offshore U =1111111111..•11•111.� ��rJ,:' .';l��1
lax distance offshore : >1Kl• `1rN
channel �-� �•
ubic yards _ ■� ___
Erail I illn _ . __ [
fuse/Boatlift :• �■�■_II A� trr I`
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ne Length Q r ,:alb iminmu
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not sure yes •�_ 1._ �1�_v
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gs: not sure yes
irium: n/a yes _IIIM II—IIIIIMIIIMI•®_•
Attached: yes no ;A _�i•
., `� IM=�®��yes / .„2
ling permit may be required; by: gawps c,.,c k 1 ,„„v Y` 1 1 See note on back regarding River Basin
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JOHANN t DOKI±N WA( NIK JKL1 '---
.; 524 ADMIRALS COURT S.E. (# `.1
1 I BOLIVIA,NC �8422 /i'Cp /I) Date 66-19/530 NC 1
6230
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Order of Pay to the �- - �-0-u
114
s Y' Ii
110 H V w RE D w Dollars n
j Bank of America
��� Bank of America Advantage
� AGH fl/T 05300019 �' ),
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ForlEPl.1JC- PAR, 0C Pt�� — — s— ^�' 0
ileo 53000 L9'61:` 0006 2305547 2116 856 � '
NarlaM Giarke __. __. _ _ _. _..__ _-.._._-._._.. _... _. —..__ __. -___ __..- GUARDIAN SAFETV®BLUE

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F.Easley,Governor James H.Gregson, Director William G.Ross Jr.,Secretary
Date give/0
Name of Property Owner Applying for Permit:
.\O QtJN WA NtQ
Mailing Address:
524 brk r2. Ls c,,. s,
aOLty ► , N . 2 4- '?
Sc� £�s;�2ti t-tA��tic corms;QP.CS r't
A?;7 1-2_0c„s2sv Lc tz . 1k) ILrtk KIc2
I certify that I have authorized (agent) S Q CG N to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct(activity) 12,E 1-1 t G r ?( Z_ OVA
at(my property located at) 5 2 4- A C.T . . COL kV t ter .2.)4
This certification is valid thru (date) EOM�( � G ►u+� �R G1. c

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Johann&Doreen Wagner
524 Admirals Ct.SE '-
Bolivia,NC 28422 L_._.-__.--
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09/23/2008 04: E7U 4icar�ruwJo�
FROM :JOMAM , I3EN WOuNEP FAX NC. :910 842 4624 Sep. 22 2008 06:24PM P2
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(7O1 A PIWMOORING P1ldNGSs/,SOATLIFT/BOATAOUSE)
I hereby certify that I own property tutacem to C.4 A N 1,4 Ylik ca 1"K P, 's
(Name of Property Owner)
property located at 5#2.4 D !'11 R.A L S C7 . D! 6 a
(Lot,Block.Road.etc.)
021 .6.D41.1(6.309 ice?;E'►b3 V tt'� , ( 2u+ssw tGkerGL Z$I:C.
(waterway) (Tara and/or Coast)
Appli►atnt's phoee#: A 4 Z.- (if 22 M Illitt$Addareae: `'Z4 ADM ►Q a Lt. C.7. Si-
^. 1%1C, _VjeWL.1.
He hall described to me,as shown below,the development he is proposing at that location,and,I
have no objections to his proposal.I undorstand that a pier/mooting pilings/boatiitt/boathouse
must be Get beak a minimum distance of fifteen feet(15)from gay area of riparian access unless
waived by me. (If you wish to waive the setback,yogi most irit al the appropriate blank
bellow)
V I!iglu wish to waive
I&wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEYELOPMNF:
(re be f f Lit by Individual propoaitg development)
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Quforssafioat for Property Owner Appbing (Rl eriaa Property Owner Information)
for Paeelt)
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Win;Address Signature
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