79864_Dale Anderson_20210728

eLAMA/ Ci DREDGE & FILL G� :'i Ott i
' ��� I.�C ' -1 - � ��3��j- A � C ,D
GENERAL PERMIT W ( Previous permit# 50 r g
> GNew ❑Modification Complete Reissue LiPartial Reissue Date previous permit issued -
As authorized by the State of North Carolina,Department of Environmental Quality 1�117 N� ZO Z�
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC CS 7 • �Zdd
Rules attache— —
Applicant Name .414 L ��&5p) Project Location: County S�Lti �-qp
Address ?jy 2- tJo�T�'Vi'td t) R Street Address/State Road/Lot#(s) p FQ STZ 19)0
City areeilli;/LC. State/"A 9 - ZIP a 715 & ( / 13 f ' ' - ve
2- clatt�e,,r,ov_� r1v~YS M `�Subdivision �ww hi its Phone#( �_ �1 E-Mail �i-a 5sol 1a S.�,,.., / ---
Authorized Agent - City C. 7OL»c-4H i ZIP ____5
Affected CW iXEW XpTA �!ES ❑PTS Phone# ( ) River Basin 7M / 4rs4
OEA 0 HHF ❑IH UBA N/A
AEC(s): Adj. y Wtr. Body_ moo, '1 tt W RlJ�r nat man /unkn)
J PWS Closest Maj.Wtr. Body C__ z la.c\ -1
ORW: yes /0PNA yes / ))
Type of Project/Activity Sly S al f6 A tv slept)61....". ?/cat J;i
(Scale: NI f4 )
Pier(dock)length_ _ •
Fixed Platform(s) -_ i - _- - 4 •
'..-
Floating Platform(s) 8 !
g pier(s) No X l0 •
- _.__
Finger ;
Groin length
I
number - .-, : — : 1 , I I , i
eR
Bulkhead/Riprap length_ - 4-
avg distance offshor:
max distance offsho e # anF 0, - • :
Basin,channel >�
cubic yards
r
i
,�Boat ram ! rG 1� " 1
Boathouse/Boatlift ! - C- i . _ , _.,r -
.Fre...; i
Beach Bulldozing - - ---
i
Other 1 - —
f
Shoreline Length 17. O C J r - '
SAV: not sure yes no : ._ . -- ;- C _ . . ,
Moratorium: n/a yes -
Photos: yes !
Waiver Attached: ig. no - _..
A building permit may be required by: %erktgeL e. . See note on back regarding River Basin rules.
• (Note Local Planning Jurisdiction)/]-- . /
Notes/Special Conditions / // h F�pd.Se S 776 6 3/ - Y z etinkv
' allOwet) is b.gO - Y. ?
Zi_k_el I . eroA) &A y g-27171
Agent of Applicant Prince ame Per it•fic• 's Printed Na
- - - ---_ID --
i n ure "Please read compliance statement on back of permit" Signatur-.
be -
Application Fee(s) Check# Issuing Date Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
4'tul' d qv)Olt rSc i �^rtv'er5
I hereby certify that I own property adjacent to aLer4 `� ,s ssc,c i c-res.
property located at i 10f O� f�l G i"'Prop .C Ow 8
t
/N�1 -�l
(Address, Lot, BI ck, Ro d(etc.)
on f9llwt
iLI o . eel �e / , in eti J k/-(- , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatioq.
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 dra ing)
Drzv0 hawiJeG 4A, d; ` LiO6t
C pi
litEra
d a
I f3oYr
! :
0
•
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.)
A./ I do wish to waive the 15' setback requirement.
•
I do not wish to waive the 15'setback requirement.
(Property• Ow rInffoormation) (Ad'acent Property Owner Information)
9,t,
Sa atture - Signature
4,,Jt ar �5n-l5c ��.
Print or Tye Na a Print or a Name
23LI . W �r VtP� !2 �5 13(
Ma 'ng.Address Mailing Address
rCe4viI[e ILL on 5t Chaco tr<�-�v� tiC al t1
City/State/Zip l City/State/Zip
-414
TelephoneN{rz er Te kph` 1?Number
Date Date
(Revised 6/18/2012)

.
. /
f
.• .
.,..
- ,
df
....m4ti _. 4i.5". . 5? i
•
.y(4,)._._.?1,( ef../r. .9!i.W_ - . . _ -. _
1 6feay.3:Q_, Lo.01/5•44 4:0,. .,r124., ‘;' . 411,P.Q..: _..44013.4...., ..41
D . ,
i' i..1 ..'.4.5414(i) 0,-,Irs ,..0;._:,....AA,,Anifiet_con5 la ._.',:„.4 e__ /5:4.y_:_ /.:_1. 7:41,/:'":-,i;_ i__.4/.44),i
1 illr
,711:=P'-"-- --411'5#.4e.ct, ,_.:4 . .._. _ ..r.4_ IC _,(0-:::_„--,-__gt or : id64,1 _ ,pi-._4,.,..'.-__-_z,:e41_11_.__.0
ld °° .� ,
- - d); C k ' '...4I A i S' eqrAkrlipil-4- .0
fr)4etaaa Oti g/2412., ' '
ye' vel- 'e.:1
• ' ear ' d -55 • 464
r.:j_ g____ ,T _...__ ./.... ...3 _ ,_._._ . .. „ oRivii,„ - coal, , .
- v4.44. ,.,
lz.,. _.:,„..... ___:4_7A4-4-.
. ..
__ ..., . .
L.1,,.. ,_,,_..„1...z ..:_:.... 8-.21. --.47.41.,._., _ ..... .___, .... .
.,_. - . .
(y
. ` - .. _ - •_ - •__•» -• .. .. _ > .n ..<.�s+. se•�:ci^s....:ar.w:c+ir.-ar,=..swr.�rtu_.:+-:,,+..-.,w�.aa

•
ADJACENT RIPARIAN PROPERTY OWNER ggSTATEMENT
I hereby certify that I own property adjacent to Said - A�1 '�r5 's
/ (N a of Property Ow er)
property located at 6. ( Q0-`/ .V,2-`� e- C orat.J t '4i-1 fJ C a'7 ��
�.d (Address, Lot, Block, R ad, tc.)
on pC...-1", LrCO a e , in ('ad 4c-+ , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Iocatin.
✓ 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) p
r�' ' De o i clout D{C. IC- e_ sfw� ,e.z.4IL)c/L Ftal�r-vt
It 7
t 777
r 1
s ° 0
lbXtb p:0
plron
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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)Q (Adjacent Prope ner I rr
•
r ` ?
& ,
( .
i tur 0 iQ z re
JtvJct( �...1.cr5 '' GG/14 f 1v��'1P� (4i Cq �eof•4
Pri t or Type Name Print or Type Name
�C1.7. - v k-t r J•e.A.l 0 A
51,1 /„ ?J w
Mai'ng AddressMailing Address
yaatfin Citj/State/Zip
aS-5,
Telephone Number Telephone Number
2S2- c3'- 2371 g- Z -za 74S-21
Date D /Z / Z-v Date
(Revised 6/18/2012)