Parham, David

NCAMA / ❑ DREDGE & FILL W 78973 A B D
ENERAL PERMIT Previous permit #
Mew ElModification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC ,s
Rules attached.
Applicant Name Project Location: County ___p
Address ` f' Street Address/ State Road/ Lot #(s)
city
Phone # ()
State / V C'-ZI P
E-Mail --'
Authorized Agent /
Affected ❑ Cw P#TA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ PWS:
Agent
❑ ES ❑ PTS
❑ UBA ❑ N/A
Subdivision
City ZIP
Phone # () River Basin �l9
Adj. Wtr. Body r�-.� (nat ma /unkn)
DCM-MHD CITY �� - 'Idi� 1
nAure W*'`Please read compliance statement on back of permit *
1030
App ication Fee(s) Check #
Permit Officer's PZte �
Signa ure
f
Is ing a xpirati n Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
J��� d PIoCrt� � 's
I hereby certify that I own property adjfacent to (Name of property Owner)
property located at
Addrei's, Lot, lock, oad, etc.) �O
A7� �� N.C. .
on GAI��I , in A' I /l .ci
(Waterbody) (CitylTown andlor County)
The applicant has described to me, as shown below, the deveiopment proposed at the above
loc ti
I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
a
IL dll �G
CAS) G. �. �J lJ 2W .._.
51
WAIVER SECTION.
I understand that a pier, dock; mooring pilings, breaktivater, 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.)
C ! do wish to waive the 15' setback requirement.
0
I
I do not wish to waive the 15' setback requirement.
print or Ty,Qe Name
ation)
A nti
(Adjacent P7opertY Owner lnTormaTlutil
Sianafure
Print or Type i1i e
_Cv i0
rVlaif'ng Address N 7a �r
�5 b�r�u,er�
Teleph ne NU oer
vate
(;Revised Si1812012)

ADJACENT RIPARIAN PROPERTY OW_N-ER STATEMENT
I hereby certify that I own property adjacent to ho19, S
&N f1 erg 's
(Name of Property Owner}
property located at c� lV I, ' �'
(Ad ress, Lot, BI ek, oil, etc.) OAT
A.7 ��� �-
on ��1���� in ¢ eI
, 10 ri�
(Waterbody) (City/Town andl r County)
N.C.
The applicant has described to me, as shown below, the devefoprnent proposed at the above
locatio
I have no objection to this proposal.
I fiati�pbjcton
DESCRIPTION ANDIOR DRAWING OF PROPOSED ]DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
A,\d P; l; „�s
All WAIVER SEc I ►u -
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin
back a minimum distance of 15' from my area of riparian access unless waived by
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
nformation)
Sic-ature
6 s
Print or Type Name
e Ni{mber
/ )•o )-,J
Date
IS' setback requirement.
/V c,
(Adjacent Property Owner information)
i
Signatz e
Print or Type Nas
QU `fox
Mailing Address
City/sta te/z-ip
TelephonN�x,, i v - ---
i, L
(.Revised 6/18/207 2)

ADJACENT RIPARIAN PROPERTY OWNER�jSTATEMENT
Q p>n p.4 0 vr\ 's
I hereby certify that I own property adjacent to �� °
(Name of Property owner)
property located at .3 �o w I Dis' r �'
(Ad ress, Lot, BI ck, oa , etc.)
on ��Y�z�'�
in P !� S ades (APero:,.I N.C.
(ytlaterbody) (City/Town and/ r County)
The applicant has described to me, as shown below, the development proposed at the above
I catio
I have no objection to this proposal.
I hav_�objectons to tL1is_pcopos-aL_____-__._-.--------
DESCRIPTION :AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
Ao
V
I cC�` �1fi�,vv oC•I� Q„a
,falVEi� SECTION--
�` _ --
I understand 'that a pier, dock, mooring pilings, breakwater, boathouse, r groin must be set
lift, o
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.
nforrnation)
SiLmature G
Lo—� roJjU
Print or Type Nam
i ai g Ad ress'
City/state/Zip
-', `.0-- 7�zS
Tele n ne N tuber
Date
(adjacent Property Owner imuf111-- )
Signature
�-e-
Print or Type Na
Qv Sox �.C�
Mailing Address
C7:� aa��L �a2ct�
city/state/Zip
Telephone Number 6 v 'x)
Date
RECEIVED
(,Revised 6/18/2012)
MAR 2 4 2020

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ �✓�` c (Name of Property Owner)
property located at /31 A' // s Lot Block, ) od, etc.
( d�res CEI ii% ALE l N.C. .
in
on in
(Waterbody) (City,Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc t'ti I have no objection to this proposal.
- -- - —DESCRIPTION zANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
e,
Lot
WAIVER SECTION QN
st be se
V....._ _. -.
I understand that a pier, dock, mooring pilingQ , of riparian access
b essounless waved groin
mue. (If your
back a minimum distance of 15' from my area of riparian
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.
Fi
0
rmation)
A►%
Print or Type Name
IN". x
i 'ling A dress o `
City/State ip
Telep' one i Jumber
Date
(Adjacent Properfiy Owner InTorrnauum
Si anatu-re
Print or Type j'NlWre
roe,
N1a�il�ng�Add)ress 7
IEfCX.Y� D d rr) U-PY" �
Tsleph9ne Nu ber 'RECEIVED
3toq 2�
Date MAR 2 4
(,Revised 6/18/2
DCM-MHD CITY