79066_Timothy Mitchell_20210218

1
0 Le-CAMA/ E DREDGE & FILL -#' 8 6 i N9 790 A °
G N E RAL PERMIT permitNd Previous #
� ' ew ��Modification EComplete Reissue ❑Partial Reissue Date previous permit i A/�
As authorized by the State of North Carolina,Department of Environrnental Quality / n
and the Coastal Resources Commission in an area of environmental concern pursuant to ISA NCAC oil--/a /2k. ,
/ ��,�� / /� � attached.
Applicant Name ,s«oj�y, 4t/�A, /e,'74 ejf • Project Location: County'__ ` e,,,
Address
,/� /�/ ,ti It f "Z'e'e/ g r'✓e-... Street Address/Sate Road//Lot#(s)_,rs e,/ /Q A
City_ /1griar/!. / State he ZIP ..2Z.•2( /f /co SZeee, f c+ of L—'4,I 1 ,/
Phone# (J76)_ 3'4 q-7SS6 E-Mail r ,/,14 44//eNclo e,„„ Subdivision JI//.�
Authorized Agent /i///�
-- ------ city0.0--ert:.p./a ZIP .279
n cw atw DP'rA [ [iff Phone# _._...__ River Basin �f,. S'.ry
Affected ( ) _ �/�
AEC(s): 7 OEA L]HHF CIIH UBA ❑N/A /�
El PWS: Adj.Wtr. Body l �a�o']cr,,»� �/man /unkn)
ORW: yes IC)
no PNA yes /C;"_'_J Closest Maj.Wtr. Body ..yf '_'.l.!®_.,�6i.., d
Type of Project/Activity /u T!n os`,�G ev J k$i10,er , /-4 /Q „0„,, 7�,., a„ c�(. 4-7 t ek�j
hoc>IL/74 a� i,_
(Scale: �„ U )
Pier(dock)length 2..c.-,5
Floats Platforms 'I 1. ` - j . f t
Fixed Platforms �_• -1--- -- ,
Finger pier(s)s ' 1 i ( -. I..
ng P () � 11--�-- --}--�--I — --. �•i'--! -a--, i t � .I'1' /j�� r'<` ��i i I
1_. I
ii ,
ii
Groin length , y, _„e y I -Wi _ _' T' ' f i I _1 i ' 1 1I t _' 1 ....__i --r- -
�.'(_KorJ( t I
number �ys.r=J� ._._. 1 1__+ `. . j...._ . _. i i { I t._ I
• Bulkhead/Riprap length .--i-_.-_1_--- �' i 1 -.� 1 I I # ,, , f.. i y__j #...I .. j
` 3.
avg distance offshore i_.s _,..�_ I I �...._...i _L 1 I 1 1 ._.I ' t, _ I_ 44
max distance offshore I •T ..-j-"` f- } I
I ;
Basin,channel __ ..I.- _ ( 1 r_ .L I ' —
it
• 1
cubic yards ---r-�- ) I I i ..h. .�;- - I } —t• = -.I-_I- _ . • f
r.._ __._.......}_.i__ ._ I
Boat ramp _.. }_..`.. +-.L. ._... f,...1 �_ .. r+j
Boathou J j.7>/.71 - -j i
I
f +
t
I -7--- --t_.. -.l... —, 1- ¢--_ i , t• ._L l
Beach Bulldozing
Other 1 I• • '+ i 1 - ,.. I 44-4
l — i
rl
- —
t 1 l I i {
,
Shoreline Length o .s - I f I - `ll— 11 I! __ I - i.-f . I ;....
! �T � II
SAY: yes no ,., i i ! I I k I i j 1 j y_,... 4., i. ..} _{
i- !
,
.___..•_ .. 1 I h^
Moratorium: n/a yes _.:L010 L ..... +.p. , ,.. ... i
_t__�1�
© no r.d a1a. T__ ;
Photos: � -� �-1 }{.
Waiver Attached: no . i 1 iJJ/__�. i 41 1-_, - ._ • - '- ! ce+t�c•-f,i. -1ic i ,... Hric i. irc4I0r�;
A building permit may be required by: .. See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) ` / / /
Notes/Special Conditions /rJ,/er/- /s: t3 J..t e N/ 7c M Qx:r S kj- C oJ:i cte T� _(/b v<4-r-mot,.c1 /O-' /z ;
er hGrJc' Ot L// s /, / fernn< , /... 1 „ .Ulin c A, r's.2e- / - .5e'e- 4420.0
.M /G
c G `
t f
Agent or Applica e Permit Printed Name
Signature �'Ple a read om y* y
Si
8 pl statement on back of Signature
itf,2-- ; 122--. .2,924iSo/ ,2/4"/„.2/ ‘ /1 t2( ____
Application Fee(s) Check# Issuing Date Expirat on

� AMA/ ❑DREDGE & FILL N. 79066 A © C D
GENERAL PERMIT Previous permit# A/�A
> L�New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit isfued A/A(
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 15A NCAC Q7/i, / zoo .
/ �� / e'Rules attached.
Applicant Nameamy Z;*o,/ /6�i A-e Ve,'/. i1' Project Location: County 4/lG
7
Address /7 44,-lei 'Zee Dr i'✓G Street Address/State Road/Lot#(s) Xreel /D A
City 4 rife•-i v 6/ State,/[t ZIP .2 228 V /e.-wX.,„ _aoc</ /c' al in,4/I G le.- 4
Phone#(3'6) ,'(q/-75-CO E-Mail S le4e//@J/doIy,co , Subdivision ,/I//4
Authorized Agent VI/7A City 7 -rze ale ZIP 27960
Affected ❑Cw Caw ❑JP'fA lE EtIqi Phone# ( ) o River Basin .n
AEC(s): OEA ❑HHF ❑IH ❑UBA El Adj.Wtr. Body I�"+ /60 _roe.,••c// //man /unkn)
❑ PWS: / d
ORW: yes / no PNA yes I ,o Closest Maj.Wtr. Body �'" 6�
O l 17� S /7 t�/J r
Type of Project/Activity �u / o/ '„ f 5' . <r wiI 1Y o� ar<hoc 1. 020 (Scale:/ ,, O' )
Pier(dock)length g�X
Fixed Platforms X a --I I ! I
I ''1/I � �r'K1 r+ci }
FloatingPlatforms ! f1541 t
Finger pier(s) } T-
i ........ I ' --i ._ _--- i
f� _4 A1.
Groin length P w ,• 1 I
number — i ____ I i
Bulkhead/Riprap length — — jj
avg distance offshore ' ! { Hill .
max distance offshore I I ` / Pi;
I, !
Basin,channel 7 1f I
�~
I :! ,moo `
i
•cubic yards '
'
Boat ramp / /1,(�grpX • ; I '
}
Beach Bulldozing ' i _
Other ifAr
!
I
''I I ; I I '
,I 1 1
Shoreline Length oZ-5 I
• yes no
Moratorium: n/a yes e /f � — — ��i�
Ly __
•
Photos: no S4 K d /?!44.l� _ j.'t _._.._ V, 1:_... .. _ �.._ N __,.
_ i 1
Waiver Attached: irgr no I „TLLc/� f-'20...i 4r I �Io rf S�t / r�µ.1<bk P�(r.j
/ 1' . R-P.e✓c l /
A building permit may be required by: #y fie.- p . 'lee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) / / / / /
Notes/Specciial Conditions /`J,/e l J,•-,e ti -/--Jr;1,,,7 ex,S fi'� Con ere T� ci i v</ -s_ / /05",<
rt(�/O. /U'Cn f oc✓I ice/ L[/' X ' I-0. -1 /-einnCn -1✓7, I.JJ/dr. "an Can gr'��.o—� - 5 4bO.z
p1•19 cr u. l•nLI" S�f y+1 4Y es o"de--- L. �hrt are 4/2/api,k,,-4
5'44nG /T / /-yJ /f
Agent or Applicant Printed Name Permit Offi er' Printed Name (�
Signature **Please read compliance statement on back of permit** Signature
D -- _Tv?y5"/ . 2/.,/�/ 6 /Jl22/
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-72 I 5)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret, Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves: Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

0 CAMA / DREDGE & FILL N° 79066 A N C D
GENERAL PERMIT Previous permit# v/ '
- 'New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit isgued ;//9
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 I5A NCAC .
/- // J / ©Rules attached.
Applicant Name /'', //// •/0 .4 V /�J tr l/ Project Location: County
Address /6/L/ £ G+7 r /t r /i i ' //�/,G Street Address/State Road/Lot#(s) 4,-,-, / /, A
City , ,/,.// State '(/� ZIP ..?7:2 V i �' � � , t /ci
Phone# ( ) L-6,N /_-' E-Mail L, I/ /./,r//��J/,-/o,/7, Subdivision '///, /
Authorized Agent /V/ City L, r<, c,I e ZIP 79e'a
Affected cw EW ❑-PTA El ES OATS Phone# ( ) River Basin if--;, //�'
AEC(s): ❑OEA HHF ElIH ❑UBA ❑N/A Adj.Wtr. Body -., /c., .. -el of /man /unkn)
PWS:
./. ,
ORW: yes / no PNA yes / noeiVi?Closest Maj.Wtr. Body
.-,, ' _.
Type of Project/Activity t-' 'k/—-
:›2G n
(Scale:/ ;�C� )
Pier(dock)length — ''
Fixed Platform(s) j , X , + , / j j t I I , flee' x IC
Floating Platform(s) o�el
/ ,,.,r t:O do 4.c j I -it ‘ I �, 7 I n,1
Finger pier(s) 1_4 i. _ ._-----. _
Groin length } /•6% f1 y be) , , ,
i i _ i
, •
number -- — _�a- -...i-- I c. _ �__�� _—
Bulkhead/Riprap length - i - .._ 1 I ..__ i I I i u --
•
avg distance offshore l i + I
max distance offshore ' _ I
Basin,channel 7 ! I'
/ i I Sir
• ��—moo I
cubic yards - ! j
,
Boat ram
(
' 1
P 1 Al / r),a,,,,, 1:, i i +
Boathou Boatli ---"—`" ...__ _
+ — �I
Beach Bulldozing ---- I + ■+;/'
Other i �j j ~S, ,. 1' )�
•
Shoreline Length .J i ( 1 i
f 1
i
SAV: not sure yes no i — —
1
Moratorium: n/a yes no I )/1-' 114 y. ..... _ . ... '
f � ..
Photos: •yes no 4 i 1,n e' Ill... Z i+ 4 _
•
v ,
Waiver Attached: yes no i I - - .� I._ I t j'`I. ) , I .. Ic.•rz.�� /
1/ / /_,.. 1, i. re ,-.�..
cl
A building permit may be required by: // /e ( 0 l�. .ee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) / /
Notes/Special Conditions ,,.,e N y rr ii &.i; {'' ( vk,r re /1 /Z.
J // I
/
/` , /4/>�✓f
Agent or Applicant Printed Name Permit Officer's.Printed Name
et
Signature **Please read compliance statement on back of permit** Signature
&'" ". .2 q 6 7 . V -/1 / //i1/2(
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action;and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford,Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden, Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

0 CAMA / DREDGE & FILL No 79066 A BCD
GENERAL PERMIT Previous permit#
�� ❑New ❑Modification ❑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 15A NCAC •
❑Rules attached.
Applicant Name Project Location: County
Address r. / `! Street Address/State Road/Lot#(s)
City State ZIP
Phone# ( ) E-Mail Subdivision
Authorized Agent City ZIP
Affected ❑CW ❑EW ❑PTA ❑ES ❑PTS Phone# ( ) River Basin •
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body
r--
Type of Project/Activity .
(Scalel
: ' ,mac' __, )
Pier(dock)length ,
Fixed Platform(s) / -' j
• I
Floating Platform(s) ( I?"' ' I.,
;
— 1. \ ! _ F ; `
',. )
Finger piers) y _.........-.- - ._.._
t j
Groin length �! �� , 1 j
number — ., =� ,` — -- —
!
Bulkhead/Riprap length �� ----- __,.....' � �..,..... ---._.__..--_-. _.—._..._ .__� �
1 t . I
avg distance offshore 1 ,, I ! � jr� r
max distance offshore ) ! � i I
Basin,channel 7 ' G i + 7
}}
cubic yards ( ii
I III ii ! __ I
1 i—+ } i
Boat ramp /
{
Boathou Boatlifti
�/
.— 1. __ + —
- 1
t 1 _ II _ -
Beach Bulldozing -- - - --- i { I i` I
Other 1 f' ,I/I f �7.? 1, -
•
\p , t
III
, i
Shoreline Length __
SAV: not sure yes no I } -------
Moratorium: n/a yes no t%f 4 , i .. ( I
.....* -- ; . - •f l r + ,�......
Photos: yes no 1 --'
Waiver Attached: yes no1 I < r
i.,.
A building permit may be required by: // . 1 .See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions 1
•
Agent or Applicant Printed Name PermitOfficer's Printed Name
Signature **Please read compliance statement on back of permit** Signature
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-648I) or the
Wilmington Regional Office(9 I 0-796-72 1 5)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

ADJACENT RIPARIAN PROPERTYtt OWNER STATEMENT
I hereby certify that I own property adjacent to t�i 1)k iU1�;' ' .1 VAC ` ej c\(�I� 's
fl A n ame of Pr erty caner)
property located at i (.,v ` I.1) ., ►a,'-`.'i i,v 'O(% ' �0(1„
i j (Address, Lo, Block, oad, c.)
I on I.� ; m �JC-ra(A Lf', i t '' �ui1 , N.C.
(Waterbody) (City/Town a d/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. ' .
t/ 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)
fi t, A Q ,r(Aw M Cv - I r(4v, W i% Cu,a1 BOO-.
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.
(Pro�ps yrt them Information) (Adjacent Property Owner Informatl tr' j
I- tee I'.�Lz :: .
S
i paiinN .44v-t rlu e*
Print or Type }rme1 P �i Typc ame
Clie c_ .;.iret, F1 ct Urtq 5v 1e tAxt- _
rung Address ,. r!r .g Ad ress
" 1t-n�r��r�1S tNC. 21 ���i tr.4 e\• ( to `�A0t45
C ttte/Zip_. y/ tat
Teleplape N�1mber/email address Telephone Number/email address
Dale r i— t1—
lhrte
(Revised Aug. 2014)
"Valid for one calendar year after signature*
r ri4.0

lt1
.��{y
JJ l 1'r
c
ftit.,.ertime- - ,
''4 , ,.; .t om'` i, mi ,,,`fie d e k
8 i ^'j3T7�^.rlk k:.
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,
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i
fib. la (t��z'/5/� c�2 e /��cu � s�o���� �u�yS �� ��

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 1 AU Q1`rb �n V tlQ (� uv C`n 's
.,q h ( ame Profterty Owner)
property located at 3 1 \ Rif\--6\ C�, \( \cn(k(A
Q (Address, L , Block, d, etq G
on VAArrd
t T 1� , in U(ArfIN 1 ` �� �JIr , N.C.
(Waterbody) (CitylTowi an or County) 1
The appli nt has described to me, as shown below, the development proposed at the above
location
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)
�ee AA 4 Drinvi( , Co — pfi ', Wt 4 toOi�
J
- �11
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/'�w l do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Own formation) (Agja9ent Property Owner Information)
r
litti 14 6,„,...,,<,
__
,52gnat
,..igatiituvr *40natrivle,
�P nt ppr Typ Name ,P{►'at or Ty e NTle
Il� Yttzli r[aGI?, D4�Ne L�1I !� 1( kcU�
ailing Address Mailingivi
ddress 1
ovl
VA iF126
it State/Z' C y S ate
-1 `,1(0- 4)(iiii -- 15 _ . 2— (v I(.)0 etatti,,,,,clzke,ce-r-kiimil.
Telephones N mber/email address Telephone umber/email ad ress
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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NC Division of Coastal Management 13962 A(�i C D
Cashier's Official Receipt
Date: —Z/1//20 /
Received From: ` 4 / G/ G/ �PJfI
Permit No.: / 9 6 47 ? ys�j r
�- //� / / Check No.:
Applicant's Name: / r °" /X/ v"�- ,z 4.v� /
County: ��Jc--
Project Address: '�`'`T D ' /lip/« 1�L.,« A c' (9Gricv �� �-,�22
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent pplicant: Date: Z 1�/ /
// /Signature of Field Representative: ` Date: -2 � --2