Browne, Douglas 76794C

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�&CAMA / ❑ DREDGE & FILL
NO 76794 A B C� D
GENERAL PERMIT
Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ,/ ��y.�
a7 J4, iL`
and the Coastal Resources Commission in an area of environmental concern pursuant
to 15A NCAC -�
attac ed.
Applicant Name 6Project
rRules
Location: County
Address
Street Address/ State Road/ Lot #(s)
,r q—
City jf d1 �/� �reSState 1" C-ZIP J
QSC
Phone # () '(/ E-Mail
oCeM
Subdivision
Authorized Agent `'
City ZIP
❑ CWEW PTA ❑ ES ❑ PTS
Phone # (_) River Basin _
Affected
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body
nat a unkn
❑ PWS:
so
ORW: yes /� PNA yes / no
Closest Maj. Wtr. Body
Type of Project/ Activity ( � i i26100 /� LLt 1�t J
N /
(Scale: _ /© )
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore v
max distance offshore
Basin, channel !
cubic yards
Boat ramp
f
Beach Bulldozing „
Other
Shoreline Length
SAV: not sure yes no _ ._..—
�;
Moratorium: n/a yes no
; ...
Photos: yes no }_ -- — —
__
j.
Waiver Attached: yes no
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A building permit may be required by: ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Conditions a
Agent o A�pplica Printed NamekJ Permit Officer's
Si nature Please read compliance statement on back of permit
� Signat /
'29ij"J (6E
placation Fee(s) Check+# Iss ng D e xpir ion Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
-1 hereby certify that I own property adjacent to )r14 6-Z. A:5 L��0 tOA2E 's
(Name of Property Owner)
property located at r/ (,/(, t4 L•�-� �l 'T 4�fl K , A)e..5
(Address, Lot, Block, Road, etc.)
on 5,WVV) 1'416 CA-PJA-1-, in PIA) /T;kJ0t-L ' N.C.
(Water ody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc tion.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
DdG It� /lfo cl�-i4-7UCC red tccs'7- k-- �oA
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WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, be
must be set back a minimum distance of 15' from my area of riparian acc(
me. (If you wish to waive the setback, you must initial the appropriate blar
I do wish to waive the 15' setback requirement.
_ I do not wish to waive the 15' setback requirement.
(Property ner Information)
s
Sig ure
Print or Type Name
j z.h lk;Az-1V a r- c:f-"A
Mailing Addre A J C--
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City/State/Zi
Liz fly -� 7z- S
Telephone Number/email address
Date
*Valid for one calendar year after signature*
(Adjacent Prop y Owner Information)
Signature
%F`j��-�--ifs,-�� �9�.�/�j-. •r
Print or Type Nar►3e
Z �4 Wig _,U L•c
Mailing Address
City/St te/Zip
1,-7.7zl 7/7- Z 71 2
Telephone u er/email address
Date RpCENSO
(Revised Aug. 2014) it ZM
pCM.0j) CITY

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RECEIVED
d
JUN 16 2020
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to —DOU 6 L?�S Y2-6 LAW G 's
9 (Name/JProperty Owner)
property located at
(Address, Lot Block, Road, etc-)
on &�E 5�dtjb Ifs ANAL- , in P/NE {iP0,L S%*,t52E5 , N.C.
(Wat body) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location
have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
7 r
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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 blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sig. �t �e
1/ 6 (16 A9 B,,0,D W V E
Print or Type Name
/2-e Z.l.%k-.vier <::::/2
Mailing Address
A) Z
City/.StatelZ
Telephone Number / email address
Date
(Adjacent Property Owner Information)
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Telephone Number/email address
RECEIVED
Date
(Revised Aug. AC ) 16 2020
"Valid for one calendar year after signature"
DCM-MHD CITY

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RECEIVED r�o.
JUN 16 2020

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RECEIVED
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j JUN 16 2020
DCM-MHD CITY