88373C - Flow, V I

❑CAMA ❑ DREDGE & FILL
GENERAL PERMIT
❑ New ❑ Modification Complete Reissue
As authorized b ,t e S to of North Carolina, Department of Environmental Quality and
15A.— )I- r oO() ❑Rules attached.
N9 88373 A B C D
Previous permit
Date previous permit issued a
❑ Partial Reissue
,stal Resources Commission in an area of environmental concern pursuant to:
General Permit Rules available at the following link: www.deq.nceov/CAMArules
Applicant Name
r 1. ;r�l..�
Authorized Agent
Address �-?
t i;'1
Project Location (County):
t
City t c...
�'l ` } State
"�,� __
ZIP / Street Address(/State Road/Lot
Phone #) (�
1 —-,�C-�r'7
•'p?
�—l1 P i
Email
Subdivision.
`�--
Cny '�-�' �. •. �,� `.
i
ZIP
Affected 0CW
NVEW
❑PTA
Ad Wtr. I t :,i�a t 4�t'i"-�
❑ES ❑PTS h dY
I
i J i1� �. 1,' �/�nna4mzn/unk
( g at/man/unk)
AEC(s): ❑OEA
❑INA
❑UW
}
❑SPIMA ❑PWS Closest Ma". Wtcody
B l'l' i
{�i i.. I' j
ORW: yes/no
PNA:
yes/no
Type of Project/ Activity
-[�---•
(Scale:
�noreune cengm
L-
_
_l__
1
n
T
-
Access Length -j-�
i
r-�--
-------
Pier (dock)length
'
1
Fixed Platform(s)
I-�
I
J
`
-
Floating Platform(s)
4..
Finger pier(s)
Total Platform area r
n
•K
-
Groin length/N ^---"' __-
,
1
'-
-
Bulkhead/ Riprap length-
--
_""-
Avgdistanceoffshore "-"" ------
-
-;-
T---
-'
-
Breakwater/Sill --- _-r
i
--
-
-
Max distance/ length ��-- ` --
distance/
�
i -
'
`
_
�
Basin, channel
Cubicyards
Boat ramp -'---"'
-
-
-
-
r_
Boathouse/Boatliftv
Beach Bulldozing ---
Other
SAV observed: yes j�o
Moratorium: n/a yes rno
Site Photos: yes no
Riparian Waiver Attached: yes ,no
A building permit/zoning permit may be required by:
Permit Conditions)
I AM AWARE OF
Agent or Applicant PRINTED Name
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
VIEWED COMPLIANCE STATEMENT.
Officer's PRINTED Name
Signature**Please read compliance statement on back of permit'* {�
Application Feels) Check #/Money Order
Signatu e -I', - / 1
/C*r�
Issuing Date Expiration Date

Owasq'I&❑CAMA ❑ DREDGE & FILL N9 88373 A B C D
a A. GENERAL PERMIT Date previous Previous 1permitissued
s
❑ New ❑ Modification N Complete Reissue ❑ Partial Reissue
As authorized by the State of North Carolina, Department of Environmental Quality and the�rC-oastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC ❑ Rules attached. I /V General Permit Rules available at the following link: www.deq.nagov/CAMArules
Applicant Name
Address
City
Phone#(_)_
Email
Affected CW ❑ E W r5PTA ❑ ES ❑ PTS
AEC(s): OEA ❑IHA ❑UW ❑SPIMA ❑PWS
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Mal. Wtr. Body
(Scale: - )
..... ......
-
-
Access Length-
Pier(dock)length
Fixed Platform(s)
I
I
i
I
Floating Platforms)
Finger pier(s)
Total Platform area[
-
.i_
Groin length/M---- "
-''
Bulkhead/ Riprap length
Avg distance offshore ---'"
-
—
-+,---
-
IF
I
--
--
-
�
—
Breakwater/Sill -...
Max distance/ length
Basin, channel
Cubicyards
I
I
—
!
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing-
I
OtherSAV
observed: yes noMoratorium:
"'
—1
-Site
n/a yes no
"`----
Photos: yes nor
A building permit/zoning permit may be required by:
Permit Conditions)r'-
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
i
Signature "Please read compliance statement on back of permit`* / Signatu e
Application Feels) Check p/Money Order Issuing Date Expiration Date

t CA /.�] DRED©t'-AeFILL N. O
80685 A B r C q
ENERAL 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 r
and the Coastal Res ur s Commission in an area of environmental concern pursuant to 15A NCAC
❑Rules attached.
/� Project Location: County Applicant Name 1 �-a � � Pro j ^'
Addres Z l t Y1 Street Address/ State Road/ Lot #(s)
City -a -' (l W
f
Phone #
Authorized Agent
Affected ❑CW ❑EW
PTA
�H
❑ OEA ❑ HHF
AEC(s):
❑ PWS:
ORW: yes / qo PNA
yes /
Type of Project/ Activity
Pier (dock) length i/7
Fixed Platform(s)„'
Floating Platform(s)�k
Finger pier(s)_
Groin length
Bulkhead/ Riprap length -----
avg distance offshore ----
max distance offshore,
Basin, channel
Boatrarnp-
Boathouse/
Beach
Other
.e )! IP , A)
fI
I� I ill t.,jf (,\.t_�
❑ UBA ❑ WA
Shoreline Length - -_ _
SAV: not sure yes no —
Moratorium: n/a yes no
I
Photos: yes no IWaiver Attached: yes no ! —
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
Agent or Applicant Printed Name
Signature "'Please read compliance statement on backofpermit»•
ri
ty - i CAL i ZIP
hone # ( 1 - - River Basin
Adj. Wtr. Body i(nri an /unkn)
Closest Maj. Wtr. Body l t + / �
(Scale:
❑ See note on back regarding River Basin rules.
Printed Name
Signature
Application Fee(s) Check# Issuing Date Expiration Date

!� s
Thereby certify that I own property adjacent tc
ame o . Pr pdrt_y Owner)
property located at / a l �C'
(Address, Lot, locR d, etc.) 7
on in a�v% ��CY�`%�t -e, N.C.
(Waterbody)(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
Inration..
-� 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)
rik..v nl� /lame c,t �J
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.
(Property Owner Information)
x )
Si7nature
71�� P, f r /a 1� C u-1�-
Prin or Type Name
/C0
Date
'Valid for one calendar year after signature'
(Adjacent Property
owner Intormation)
l
Sgnature*
1� T: lq- c`> Ctj
Print or Type Name
Mailing Addre s ` j1
...�e'-
City/State p
Te ephone Num er/email address RECEIVED
Dale*
AUG 2 3 2021
(Revised Aug. 2014)
DCM-MHD CITY

r ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to V T IEZ6 (d 's
(Name of Property Owner)
property located at 2n"e � X r c e l 1 M. ��
on - in ,� N� %— N.C.
(Waterbody) S11 City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
L- ' 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)
-2
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.
L-" I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Tyype Name
�t�c/ CCgt�n.t.
Mail' g Add re s J
City/state/Zip
Telephone Number/email address
Date
(Adjacent
Pro
rertlwner Information)
Print or Type Name
i),/l y'
Mailing Address
j l4 iswl,�—
Ctty/state2ip
Telephone Number/email address
=•2' I REGEIVEt)
Dale*
(RevAJ ft32pdp1
*Valid for one calendar year after signature"
®clw-M)i®c►ry

ADJACENT RIPARIAN PROPERTYOWNER STATEMEN
certify that I own property adjacent to ✓/G (1 o ii' ltk�Lt n G
located at
in
(Waterbody)
I
erty Qwner)
c.)
vz , N.C.
and/or Countv)
The applicant has described to me, as shown below, the development proposed at the above
.location...
L'' 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, 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.)
t. I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
IvIarvy-,/=
Print or Tye Name
/DO /-/hn S'fi
Mailing Address ,(
City/state'
33(,
Telephone Number/email address
Date
*Valid for one calendar year after signature'
(Adjacent Property Owner Information)
Signature*
Print or Tvoe Name
elephone Number/ email address
Date* RFrF-NFD
(Revised Aug. 2014)
AUG 23
-m .. 'Awn rITY

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