Willis, Nancy 76645C

AMA / ❑DREDGE & FILL N9 76645 A B C D
E ERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date revi
As auth rued by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in anareaof nviroonnme tal concern pursuant to 15A NCAC
ApplicantName Project Location: County
Address. � gI Q J (1 0 r. Street Address/ S(:atp, Rpad/ Lot
City
Phone #_r
Authorized Agent
qkiz
Affected
SEW PTA
❑OW
AEC(s): EA
u\HHF
I
❑ PWS:
ORW: yes / n
PNA yes /
Type of Project/ Activity
:eINIL.ZIP
❑ ES ❑ PTS
❑ UBA ❑ N/A
Phone # 6PN
Adj. Wtr. Body
Closest Mal. Wtr.
Pier (dock) length
Fined Platform(s)
Floating Platform(s)
Finger pier(s)
I�Yl 111LA
j
Groin length
number
Bulkhead/ Piprap length
avg distance offshore
max distance offshore
Basin, channel
—
--
i
a
c
cubic yards
Boat ramp
Boathouse/ Boatlift
i
Beach Bulldozi
jjt�
Other
�-
i
Shoreline Length
SAV: not Sure yes
Moratorium: n/a yes o
Photos: yes o
Waiver Attached: yes
A building permit may be required by:
( Note Local Planning jurisdiction) �^\
Notes/ Special Conditions lly
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sir
ZIP_
River Basin
❑ See note on badv4egai
(Scale: III,
J
�-V C,.
River Basin rules.
r•
Date

Eric Ellis
Marine Construction
DOCKS *SEAWALLS *BOAT LIFTS
DECKS & REPAIRS
Telephone : [phone]
205 Nottingham Lane Morehead City, NC 28557
MEN
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MEOW
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No
CW printing, Morehead City

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ^ c./ 5 l�l 1 �' % s
I 1 (Name gf Property
UOwner)
property located at al�� S�eepy m hr, /�1cwP•'r'*.�JG
(Address, Lot, Block, Road, etc )
on 3vSv a SuJN , in /�J¢wp u4 t N.C.
(Waterbody) (CItylTown and/or County)
The applicant 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 till In description beiow or attach a site drawing)
tS X HS' nocle
of-t,L 1z'X ig'('ll
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must beset back a minimum distance of 15' from my area of riparian access unless waived by
me. (Yu 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.
Owner Information)
ignatare Signa e*
Print or Tye Name Print or Typi
I/Q Sfe An 11u..a ar. IA4? ,
(L D X -?o
email address
—moo
Unre•
`Valid for one calendar year after signature"
os� '4L•(R
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
property located at
�r.ww vaa, w., vwvn, ,wnr, v.vq
on 4ve. in /JcwDur} N.C.
(Waterbody) (City/Town and/or County)
The applicant 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)
6 X ys' hocl-
t,/f{-g WX
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 er y Owner Info mation) (Adjacent Property Owner Information)
X Signature Si nat *n A J�
Print or Ty a Name Print or Type NName r /
IL Jec to\,rl�r, '}�� M;cr�I.�CW�l
Mailingg Address'Mal ng ddress
nlewnor"+ ,AJC City/S2ta?`3 pia - a rj-ri City/Std d �2� 3 3 `i
Teleph a Number/ mail address Telephone Number/email address
5(rot,
Dade Date*
(Revised Aug. 2014)
'Valid for one calendar year after signature*