Verdetto, Leonard

NERAL PERMIT Pnwlmn t
AEI rr 00nd by"State of North tit, DW&unm or Eovilr w" Qway
and tl Rmources Carninialon in ar+ar"��ofjj c purow c to IsA NC* _ ✓ .�-- —
�aum.
>
VO
c1i?1 Subdue,
G00
-
Affectedc, cw w► s Phonec .
a Bwn
��+ tOiA HHF C IH WA i M/A Adj. Wtr. Body_Pwsl
v
may. Yes j MA „r_�'ti Closest Mai, Wir 8odyr -
Type of Pr*W Ac*ft
SAM "t oft yt% nd
mw**rww' Wti
r PhutoK 00 ,
Wow AuecMd; yew no
A bit Pem* MNY be rel*W bY.
( Nape LOW P �rke ctlof4
NOCAW AWCW Co"dwlen's .
i. i •}IAA/ '
1)41041 Harr► on.b.dt r%wmft nivw 6"m now
TP
*• Pam+ reed cw,tpli�r�. �lteir�tt on t�k orparm►t «
A wkwion Foks) k N
t
{ E p+ratiwt to

�0 C
1 CAMA / El DREDGE &FILL O 77123 A B C /D
GENERAL PERMIT Previous permit # /
lew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality ,(TT
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC Za - u6``0
,2S Rules attached.
Applicant Name Project Location: County Ccotv
Address ~ ��- t-1 e Street Address/ State Road/ Lot #(s) I
City State ZIP IX Cfye—
Phone # ( )7 E-Mail Subdivision
Authorized Agent City ZIP
Affected ❑ CW �W `EFTA ❑ PTS Phone # ( ) River Basin 1e41L5e
AEC(s): El ElHHF ❑ IH ❑ UBA El Adj. Wtr. Body V nat man /unkn
❑ PWS:
ORW: yes / � PNA yes no Closest Maj. Wtr. Body < co e3 A-n
Type of Project/ Activity
Pier (dock) length
r
Fixed Platform(s)
r
Floating Platform(s)
Finger pier(s)
s�
Groin length
number
Bulkhead/ ipra length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
r
Shoreline Length
SAV: not sure yes no --_ ................_..--
---
Moratorium: n/a yes no
Photos: yes no i
........ ......_ _.._ t .—,_
Waiver Attached: yes no
i
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ (Special Conditions.L
A 0 P 1 + �1C r / �1 Mi` /tn n t n
�J
CO Jqp ae'�50'q
f
C2g nt or Applicant Printed Name
Si ature Please read compliance statement on back of permit"
6 `� _ 1I-,,-
Application Fee(s) Check #
(Scale:
L:See note on back regarding River Basin rules.
4 A A l 0 k A 1/3+to� k AJ A

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Lundlz7l Vzrd&Ab
Mailing Address: S)q I /d/t4V&
PA J o,/
Phone Number: q- -7 7q6
Email Address:
I certify that I have authorized _SaoJer�l.: f
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 1)b�)&
at my property located at / of " 0 <U/!. ebl // DO )16 ,
in C/)
M, 20 County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
L4f&n2rd )%A6PO
Print or Type Name
0I ne-r
Title
V / 3
Date
This certification is valid through /
c C�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to P(�l%�f l�`'�c� �iG% I
f `_ // (Name of Property Owner)
property located at / (/ JI /
I (Address, Lot, Block, Road, etc.)
on !4���.�,w))yy , in l(VL Uc�4//FJ N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location,
ti 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)
52
WAIVER SECTION
I 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) (Adjacent Property Owner Information)
Signa`J/,
Print or Type Name
Mailing Addr ss
6E�
City/State)Z
�� PA 19J)'
Telephone Number/em it address
Hia-114— 114�
Date
7.23 Zo
*Valid for one calendar year after signature*
signet
P►Mt or Type NamIr�j'pr,L�rz� Cvice�
Mailing Addres
City/State/Zip/ NC, N5-3;
Telephone Number/email address
Date* 2-3 .1-0
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
t-Bwn
I hereby certify that I own property adjacent to I ) *0 's
l (N a of Property Owner)
property located at%GlC'!J%/�
t / (Address, Lot, Block, Road, etc.)
on 1/�c� Ri jIldr- in L" C'%' ' « , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
r 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)
WAIVER SECTION
I 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 In or ation)
Signature t�
Print or Type Name
_ (SI'I
Mailing Ad(l ess
1 11, 5) x, 'T4 16Ai a
City/State/Zip
i)01 '-)IJL1I- f: • i) )'A i -X 2--
Telephone Numb r/email address
-1Iq�-IN
Date T 2 310
*Valid for one calendar year after signature*
(Adjacent Property Owner Information)
Signature*
-/) JAOZa4o� -
Print or Type Name
Mailing Address
:1 ) it 69r-\1 �ar�
City/state/Zip
J'VC �9715I1
Telephone Number/email address
21t- d/o L327.2 -
Date* 7, 23, 20
(Revised Aug. 2014)