Dodson, Bob 78822C (2)

r-_ M( DNU 7gg22 A B � D/
"GENERAL 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
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules at[ached.
Applicant Name �O Project Location: County (%yl "TA2 t4/
Address I N. i ra o f S V Street Address/ State Road/ Lot #(s)
State
Phone # E-Mail y
Authorized Agent-rwo �jg___pjE4"Oy 5 f^ C
Affected ❑ CW ff A9S D PTS
AEC(s): IJOEA ❑ HHF ❑ IH ❑ UBA ❑ WA
❑ PWS:
CRW: yes / no PNA ye /no
Type of Project/ Activity
Pier (dock) length I
Fixed
Float
Fing
Groff
Bulk
Basin
Boat
Boat
Beac
Oth
Shor
SAV
Mon
Phot
Wain
Subdivision
CityZIP
Phone # ( ) River Basin
Adj. Wtr. Body I at ma unkn
Closest Maj. Wtr. Body L
Platform(:)
er
head/
In
er
I
i
i
I
ing Platform(:)
pier(s) �
length
I
n
number J
_i-
I
Wprap length
. -._i.
avg distance offshore
max distance offshore
channel
-
1
-I--
cubic yards,
ramp /5 X t>CIrS
house/ Boatllft,iI
I.._I ,.
;
�'- �'!
i
Bulldozing
aline Length 0
--1--
notsure yes
-
�../
aolam: n/a Yes
7
>s: yes
er Attached:
(Scale:
f
-
I
� /) ()
� L % i-��A I
_A)
(i�Au_; r,)
�006N 1
C
Do 0,)
r/
A building permit may be required by: _/V . _ Iflps4f U See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) ( ) '' f /J� ir
Notes/ Special Conditions Rim+ C-n rv1(7 51i Q / I .I `e n6 h/ I Jpt� �4-h a A iov
Andrew Miller
pllca�ted Name '
Signature " Please read compliance statement on back of permit'*
Application Fee(s) Check #
Per/mitOff /cjer' Printed ame Q •/I
Sig[7 �/ 1( —
Iss ng`?"e E irat nDateE irat nDate

c DREDGE &FILL No 78822 A B � D
"GENERAL 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
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 07 Nri,J
Rules attached.
R
Applicant Name 0k DloAsnn Project Location: County (Jy/
Address 502 N. alal� k/ t (J�5 Uy' V— Street Address/ State Road/ Lot #(s)
cT
State ZI P_a�y
Phone # (M)
Authorized Agent
Affected ❑CW e- `'A "i`" ❑PTS
A
Affecte ❑OEA ❑HHF ❑IH ❑UBA ❑N/A
❑ PWS:
ORW: yes 10 PNA ye /no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel ell
cubic yards
Boat ramp,��
Boathouse/ Boadift i
i
Beach Bulldozing
Other
Shoreline Length o-
SAV: not sure yes no•
Moratorium: n/a yes
Photos: yes �Onn
Waiver Attached: � (�`
Subdivision
City ZIP /
Phone # ( ) River Basin1�%1;
Adj. Wtr. Body It at a AN)
Closest Maj. Wtr. Body 411 1 PS
A building permit may be required by: N• 4 f I lf/'acb
( Note Local Planning jurisdiction) ((''�� 1 ) LL
Notes/ Special Conditions _ _ _I`���n� �-/, M
G S
r Applicant Printed Name , ^ / An
'Signature 11 Please read comptliance staement on back of permit"
Igf7K19
Application Fee(s) Check #
(Scale: I �' © )
❑ See note on back regarding River Basin rules.
h I 1 I r� r�
Permit Officer' Printed Name
Signat re
WIss ing r to ' — '.5—A n Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 1 a/y /x
Name of Property Owner Applying for Permit:
I�b �ocLS��
Mailing Address:
SoS M,. IT-P; W)-65 -J;z2
I certify that I have authorized (agent) TJo -1�91A I L ( to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)-&A7-�'16
at (my property located at) 6Q91
This certification is valid thru (date) /-?/31121
Owner Signature
RECEIVE®
DEC 2 9 NZO
DCM-MHD CITE'
Date
�d $ aD°
a -It JV6

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
hereby certify that I own property adjacent to - no, ��t� /tfr ,�C L L f 's
{� / iii ( e of Property Owner)
property located at �D� If'ficEyC(t�!/1 �jS �tr-
(Address, Lg , Blgpk, Road, etc.)
on (nail t& 30-4 in / �. 7DtJ,5/t 7-,_Qj2 (_k, N.C.
(Waterbody) I —�( ity/Town a`ndlor 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)
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.)
V� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number
Date
(Adjacent Property Owner Information)
9&1 r4alx--
Sigy(rn_.a�ture
17d- a8q � d
7(/'7 - (� y. —ice t
Telephone Numbed
Date l
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 's
(Name of Property Owner)
property located at r� b � � i � c� � � / � r� S
(Address, Lot, Block, Road, etc.j,
on in /I� vins << i I �'5 C c C Jj N.C.
(Waterbody) ( ity/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)
WAIVER SECTION
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.)
Al- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
'Signature
It or Type Name
`7cS nl. "."� '.J �L
Mailing Address
AJ7r-40J t t& .2i H6
City/state/zip
t-"ir9-boE-7tiye
Telepho�ne Number
I �/%,1aa
Date
(Adjacent Property Owner Information)
Si nature
Print or Type Name ,
✓<O Iti. /U� � "ti
ailing Address
/-LKeshara r /✓C'
City/State2i
3:z� �a1.33v�
Telephone Number
/ / -'� `i-,�- o .Z u
Date
(Revised 611812012)

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