76434D - Grimm

1 CAMA / ❑DREDGE & FILL N9 76434 A
3ENERAL PERMIT Previous permit# _ B/
'lew ]Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued /
^ized by the State of North Carolina,Department of Environmental Quality t�
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 7/7 • J/Oc
' n ❑Rules attached.
t Name M all L Q,r I t'c G r I r^i Project Location: County rib r 14n f•!„J1 c R-
1 6 Soy 7'1 Street Address/State Road/Lot#(s)
Oc --I strayd State ZIP ggigos 5/f 1-1 1,.i e s ri-T)l,A►r
(ct/q) S I Z-03f1 SE-Mail re 1 r r®r Ord'4ubclivision
ed Agent /'1 LI"►W C-OrN M AX'1 N._ cu vice c City Da k—=C/o44^01 ZIP .-15.11
❑CW VEW )(PTA XES D PTS Phone# ( River Basin LLtN\
❑OEA ❑HHF ❑IH ❑UBA ❑WA Adj.Wtr. Body r14 n "LAY ii57i 1 f99 ti /
❑PWS:
/ PNA es / o Closest Maj.Wtr. Body TA'w►
Yes no Y
'Project/Activity Q P j)1 ace_ D IA.I DACI ('2.' t v\�cov��. eS4►vc VtA.\ `t
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atform(s) I {
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ier(s) _ �� �y
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mber L
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ddI prap length 5(J‘ ! —._.
distance offshore 2.' f1 j I
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uc distance offshore 2% F 1
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4ttached: yes
ng permit may be required by: Ttw. Irk Oam oak LSIQYd . n See note on back regarding River Basin r
Local Planning lurisdiction) — I r I I ,

AGENT Af1THOR1ZAJI /FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit. PACklitt3 Vtetet'f C_ V i,r16 AN
Mailing Address- t`0 a?lC 1'•f
(yak Isic."4:3, NC a 5
Phone Number: 9141 5 22. 0.325
Ernati Address: - rert.trimr+n r2 Air g41 r��,
t certify that I have authorized ACQ!'1 P4,•an ►Y trjr A6/1 r•, •
Agent I Ccx i,acoq
to act on my beha►f, for the purpose ciapplying for and Warning all CAMA permits
necessary for the following proposed development rept Arc_- to
-{et-t O 4 V t kfu44,11
at my property located at S L t LI Nest Ei flri V( .
in 4' 14r VICE County
I furfhormor+e certNy► that f ern authorized to ,ant, and do in tact grit permission to
Division of Coastal Management stall; the Local Permit°Meer and theti'agents to enter
on the aforementioned lends in Cotirnection with evaivahng information rotated to this
perms applicator
• - . Owner lrdformatiort
• /rt.�. . 1 fA ,
, /a_f
Signature
IA • • .• Lit r'mrn
or Typo time
ra.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own DPOPe ty aciactnt to
� atrteWIN` �
Property iscatad at 5414 1'1�Cs}' t me of Property Owner)
�►3, A L- _ Li-tap-ra L2 4
an � Uddrws,�R Heels,Road,et1s.)
In MUG tcl ,".el NG
dy) (Clt osm aadfor County!
ThaapaAtoaM has dear bad to ma,as sown below.the development Ptoratad at the above beabor►
t
.IIIR• --.. I howl no Obfecbon to the propose
I have Mentions to this proDoaa!
DESCRIPTION ANOI'ON ORAWt1 — PROPOSED __ .„DEVELOPMENT...
(Ihdbkk* proposing deve/opmont must till in description below or attach a site dra t
$a I ixtied
I�deAJknd that a par,dock, mooring gave, bboamc ee.1dt,or grom minimum dish of 1S'from my area of wen accost en waved went be Mel b�aak
the setback, you must tairi&the appropriate bionic below} b`f (If you"Ash to waive
1 do wish to wait.the 15'setback rpwnament
I do not wen to waive the 15 Nett
Ownit
( ceM OwMMt Inionnadon)
e _
ifs , ,4 , i . * im s it
Prot pr ripe
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Dote RacWvoc Dots Dopoahad Chock From aim* Name of Pemrit Nokia, Vendor Chock Number amount Permit NumbodCommenn
CM nor! Cdann! Column] Column( Cokmn6 Column& Column? Columns
9/15/2020 McPherson Marine Service,LLC Marguerite Grimm FCB 3314 $400.00 GP#76434D
9/15/2020 Anthony Carr Money Order Chad Hock United Bank 543577 $200.00 GP#71896D
9/15/2020 Emily Pace and Mary Starcher same Cadence Bank 836 $400.00 GP#71882D
9/15/2020 Donald and Melissa McVickers same State Employees CU 1870 $200.00 GP#77820D
9/15/2020 David Bilotti Carroll Noone Bank of America 580 $400.00 GP#77828D
9/15/2020 Enchantment East LLC same TD Bank 1242 $200.00 GP#77830D
9/15/2020 William Kozel same Bank of America 7103 $400.00 GP#71877D
9/15/2020 Robert Kronengold same PNC Bank 1233 $200.00 GP#78480D
9/15/2020 Thomas Cruz same Wells Fargo 129 $200.00 GP#78480D