77916A_Hugill, Paul_20201218

A / 1� DREDGE h FILL N9 77916
QGaTENNERAL PERMIT C D
Previous permit #❑Modification ❑Complete Reissue ❑Partin) Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
he Coastal Resources Commission` in an area of environments) concern pursuant to I SA NCAC OIL - I too
Applicant Name -PQt.i rriuctiII fRUes
�, _ Project Location: County t;aCt-tn
Address Oo�k 5, �,� lZr Street Address/ State Road/ Lot #(s) L© i� See
City�k�`c �k State zip2'So�*IIy W;hr eicaaaca Tr1
Phone # E-Mail _.� ��.Ctwr% Subdivision CYlrist.�cLt� bpp
i ,
Authorized Agent p c._ �� o Ctrl��r�r r city ZIP ailedlZ
Affected 0CW WIEW MPTA ®ES RIPTS Phone # ( ) '—` River Basin �ttQ�csQ h
AEC(s)- ❑ OEA O HHF 0 IH ❑ URA ❑ WA y-
0 PWS: Ad'I ,.Wtr. wCLn l'.r2/r rnan /unkn�
0KW: yes / 6> PHA yes nb Closest Maj. Wtr. Body A j ° p&J=Je S"
Type of Project/ Acdvitp kit
Pier (dock) length
Fboad Pt dorms) �` 1
Floating Piufom+(s) 1
Finger pter(s)
Groin length
number
(l!� PiPrap length-sol
avg distance of bore Z r
max distance otbhae �f
Ain, channel ^
cubic yards
Boat ramp -•
Boatfiouse/ BoatGR
Beach Bulldozing
off- Nt,�,j &1 LV ea c( .2 t
(Scale:
NEON
mom I
UNN
�.
�MEr r�al�
1 ! • ... -
�� �• �it�iQan
'+6� pplicant Printed me
-^'
T"" Please read compliance statement on
Application Feels)
Permit egfs Priipted Name
ofpermit" Sigtlatu
Lfq I- I z/ 16 (Zo ` 116 /Zr
C},ick # Issuing Date Expiration Date

r�
r�i
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1
Mailing Address: '4l e1
L1.4 Z 31
Phone Number: (75 7 % `J ,; '/ -
Email Address:
I certify that I have authorized j • .4 Ag9fit i contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ilLtYIEYI tQ wD Doctian t
in aowa A 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
4
Print or ape Name
Title
Date
This certification is valid through 5- 102,3 1 a i

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tos
//�� , /Name ofdwerty Owner)
property heated at _ ��� � Vl��-� �
i[� (Add ess, Lo IocK, Road, t>�___-. , N.C.
on Waterbody} in {City�Tawn and/or County)
applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Ind(Wdual proposing development must fill in desclipdon below or attach a sit,$ df*Wing)
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 16 setback requirement_
(Property Owner Information) (Adjacent Property Owner Information)
Signs v alvialirp
goal,! {�,la." Q --- ' 1�
Pnnt or Type Name U Print or Type Name
Mailing Address Mailin Addross
C.tyVSrale/Zip CrtylStataOp
"755-7-- r 8 r7 -::� —?
Telephone Number / email address Telephone Numb / email address
Dare �-r— Laa&*
(Revised Aug. 2014)
'Valid for one calendar year after signature'

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to r"Q,a Okus
!2 !� Name of roperty Owner)
Property located at t'{�j�A ( -wit
(Addess, Lo loc Road, etc.)
on1oul4n In , N.C.
(Waterbody) (CltY7Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
1 have no objection to this proposal,
l have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
{t7L4ivldtl81proposing development• must fill In d scripUon below or atfach a site drawi�
r
� � , : j t � f• err � ��
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 Corner Information)
Sigrrae '
�to z
Print or Type Name Pant or Type Name
-f.46 ©AIC 6, V E Z D aka � t r1�u.i?4
Mailing Address M ding Address.
n > of r— �Co u.rl 3� _ _ Glut ,, �`r` I t �—
city/5tete/Zlp City1starelzip L
? 1 7— 7.c—t, — 89 Y� ��� IL.�3� 61 � �� .
Telep one Number/email address Telephone Number/email address
OK
Date Date*
,� (Revised Aug. 2014)
'Valid for one calendar year after signature'

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