Barts, Susan 76757C (2)

..❑CAMA / ❑ DREDGE & FILL N9
76757 A B C D
GENERAL PERMIT Previous permit#
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permitissued
As authorized by the State of North Carolina, Department of Environmental Quality ('/1 y t/ ,
and the Coastal R�sot�rces Commission in an ea of vironme ncern pursuant to 15A NCAC Vim/
CC n ules attache .
Applicant Names[ 1 Project Location: County
t I l) AA L11 I —
Phone #
Authorized Agent
Affected ❑ CW ❑EW ❑ PTA
AEC(s): ❑ OEA ❑ HHF ❑ IH
❑ Pwpe\
ORW: yes / PNA yes /
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) yy
Floating Platform(s) IOU
Finger pier(s)
Groin length
number
Bulkhead/ Ripmp length_
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatl
Beach
Other
Shoreline Length
SAV: not sure yes
Moratorium: n/a .yes no
Photos: ye no
Waiver Attached: es I no
A building permit may be required by:
( Note Local Planning jurisdiction) k
i
❑ ES ❑ PTS
EigBA ❑ N/A
�v,Ilrl►s�_Il1I.�
M lid. i
t or Applcant Printed Name
Permitutticei
Sig lure .
o
Sil atur_ e_ f ise read compliance statement on back of petrrtpt}�s'�
Issuing Date
Application Fee(s)
Check#
❑ See note on back
(Scale: I I 7�'T
rules.
r\
Expiration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
1 hereby certify that 1 own property adjacent to ll s Rvy 0.� 's
(Name of Property Owner)
property located at 1 b � S 0.` �Yl�SA
(Address, Lot Block, oad, etp.)
oon P�>pt lC'JQ `,Rt e[� in N.C.
e e 0t2(Waterbody) (City/Townand/orCauhty)
The has described to me, as shown below, the development proposed at the above
locati
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
pndhddua/ proposing development must fill In descApdion b#kW *&dnvh a site
WAIVER SECTION
t understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16 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.
(Pr perty OwnnerInformation)
4Azoa' X �NI/)&/�
Si�alure _I
�cS4W l-l. BarL�
Print or Type Name
%. )..50 /P_yYl'54'Mailing Addr#ss
/, /gyp 7
AAnr2P ea/C./�.,&,/t/C.0�66 /
uny/Statemyp , U L'C, f in �'I uuyiararei ip
,x,,,R,R,il3l she t�f. 2��'�.-(017-00
Telephone Number/email address Telephpne umber/email address
5)ltz��o�
D\attee Date*
C � YY\ (Revised Aug. 2014)
( djacent Property Owner Information)

-
px 1 D-4-Salty
cIz
7�
t

I hereby certify that I own property adjacent to
property located at
pon
1 e. C�i e.1G
The applicant has described
location.
V IN
(Name of Property
(City/Town
5 'S
N.C.
to me, as shown below, the development proposed at the above
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► ih6dliltr6I dtlsch a site drawing)
See, `R40.c-V') 'P-A rm°`-v
WAIVER SECTION
t understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16 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 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro rty Owner Information)
, "-11 '?v >
Signature
14, ri11J >
Print or Type Na e
ID
S a.%vn S�
Mivin�r�ddti�a C, irt,NCa�SSJ7
City/ VIZip SheCa fivC/ ch6�
P
Telephone Number/email address
N/0- aoao
Dare
(Adjacent Property Owner Information)
Signature'
Print or Type Namd
l 0 7 �; r l> �, 45 I-
eeAninn A&im"
Dare*
address
.„ -%
.7
"0"> J
540 Q.0'0 N (:@ ee ' r �> CO ly�' (Revised Aug. 2014)

,
(
e
J
.
{
/
)
}
e
}
q
3
,
�
r ƒ §
)
�/)\}
)
$
{0
!(
037ƒf
/
)
2M(E!
q|\a
(
q
\
\(
(
■