Deacon, Dan 78864C

LAMA / 11 DREDGE & FILL
A B (dD D
NERAL PERMIT Previous permit #
New'Modification O.Complete Reissue OPartial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission J an area of environmental concern pursuant to I SA NCAC o74.1
- rZWes attached
Applicant Name Project Location: County a..
..................
Address (A (110" Street Address/ State Road/ Lot #(s)/
eA/C ZIP AY� I V
Ci State_ VY
Phone# E-Mail ........... .............. . . ....... . ......... . ..................... . ......... Subdivision......--------.......--.._..._.._—__._..._
Authorized Agent City. J, 717 ­ .. . ........ZIP
1'44#fA )�ES I-] PTS Phone# River Basin
WAII-fe.
Affecte4 OEA E HHF 0 1H ---USA E�`NIA
AEC(s): Adj, Wtr. Body_ &
PWS:
Closest Mal. Win Body..-
ORW: s. / no
Type of Project/ Activity
Pier (dock) length­Y x
Fixed Plitform(s)
Floating Platform(s)
-e-
Fini4er Pier(s)
Agent
**Pleakr-e'5dccm­ ranee tat�me�t­onback ofpermit ** -7
WO
Feels) heck k �#
J See note on back regarding River Basin rules.
PermitOfficer's Pr
re
i -t-
g ate Ex iratjibn Date

LAMA / ❑DREDGE & FILL V Vi N9 78864 A B � D
NERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
Asa thorized by the State o(North Carolina, Department of Environmental Quality
and the Coastal Resources Commission an area of environmental concern pursuant to I SA NCAC
''ules attached.
Applicant Name Project Location: County �f1�
Address Street Address/ State Road/ Lot #(s) 3
Ci StateZIPJ2—ffJ7 bo�� �SIVe
Subdivision
Authorized Agent �� City ' \ ZIP s
Affected '"t' 'A )dES ❑PTS Phone # O River B sin k
Affecte ❑ oEA ❑ HHF ❑ IH ❑ UBA ❑ WA Adj. Wtr. Body q SDC na an unkn
❑/P�y�S:
ORW: yes/ ndJ PNA yes / no Closest Maj. Wtr. Body
Type of Project/ Activity
Pier (dock)length Tic,
i i
Fixed Platform(s) ii� -�--
FloatingPlatform(s)
Finger pier(s)
Groin length / number
Bulkhead/ ftiprap length r jr Y-i 0i
avg distance offshore ✓ "1) (� n�
max distance offshore
6 � i
Basin, channel — , ,y--,
1
-iT
cubic yards .� r� i i 7 -
Boat ramp
Boathouse/ Boadift
Beach
Other I
r-
i - 11
_ _-J
Shoreline Length
SAV: not sure yes no —-1 -- -
Moratorium: n/a yes no �1 j
Photos: yes no
Waiver Attached: yes n _
A building permit may be required by:
( Note Local Planning Jurisdiction), t
^ig cure **Ple read compliance statementon backof permit**
Apblication Fee(s) Check
(
Scale:
❑ See note on back regarding River Basin rules.
L

CAMA / ❑ DREDGE & ILL n pp �
-. iV . 7006. A B D
rNERAL PERMIT Previous permit #
Nw ❑Modification ❑Complete Reissue ❑Partial Reissue - .te previous permit issued
As authorized by the State of North Carolina, Department of Envir<
and the Coastal Resources Commission "Lanarea of environmental e �0o�-� `yam
ules attached.
Applicant Name �Fiw�� 3/ ry1 r l
Address �ad`/ Lot #(s)j%
Ci State � ZIP /f U�
Phone # E-Mail ��__
Authorized Agent City 1 V—P ZIP
CW RivB n
Affected�'F
AEC(s): O0EA❑ HHF ❑ IH ❑ USA' ❑ N/A
Adj. Wtr. Body �� I So( na an unkn)
❑ PWS:
ORW: yes, PNA OY.-s
/ no Closest Maj. Wtr. Body
Type of Project/ Activity
(Scale: r )
Pier (dock) length _r
Fixed Platform(s)!i—
Floating Platform(s)-
: I
Finger pier(s)
I _ I
Groin length
number
i
Bulkhead/ Riprap length
I i 1
I I
avg distance offshore
max distance offshoreT
Basin, channel
I
i
cubic yards
- * -T I
Boat ram
p -- -
Boathouse/ Boatlift
Ar
Beach Bul o ' g - !j
I
Other j ` I
i -
r
Shoreline Length I 1
SAV: not sure yes no
TT
Moratorium: n/a yes I no -_—_ —
Photos: yes no
Waiver Attached: yes n 1_� - -i-_) ,---- .M-
A building permit may be required by: j V t r { /') ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction)
Notes/ Special Co ditions MJ
Y F n All . - ! Y r. ­ / _
Agent of t Printed Name
0 `Sig ture **Ple read compliance statement onbackofpermit** .`7
Ap lication Fee Check #

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to O a,,if, kO ^ s
{Nam of Property Owner)
property located at 3 (g Sco1-c!4 06 i0e
(Address, lot, Block, Road, etc.)
on :Slue 5 ,� nry , in A n A=i* =P5Ai L 6%: 8LA N.C.
(Vllaterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
V— 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, 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.)
,off I do wish to waive the 15' setback requirement.
Z^ I do not wish to waive the 15' setback requirem
(Property Owner Inffoorma ' n)
1 � 1
Signature
Print or Type Name
Mailing Address
C '4rD-L G-Li t t r !ems -s� 7
city/State ip
Telephpne Number
Date
(Adjac t P Owner Information)
.d k d r, (></ 661L X- S L[_C
Si$Kature
��r_5 4 UJQLEE
Print or Type Name
Mailin Address
city/ tate/zip J
Telephone Number
RECEIVED
611 s12012)
LIAR 0 3 2021
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RECEIVED
MAR 0 3 2021
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