Harrelson, Charles 78873C

AMA / ❑DREDGE & FILL N9 7887" A B � D
NERAL PERMIT Previous permit#
GM/New ❑Modification ❑Complete Reissue ❑Partial Reissue Daze previous permit issued
As authorized by the State of North Carollrta, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 74 CY5
auks attKhed.
Applicant Name I io"; �S' W Project Location: County-
Address Y-17 Ovmsr r ljto. Street Address/ State Road/ Lot #(s) 6,2 FAIAsk
City �(L,G 1 04� StateC IP
Phone # W)�E-Mail
-
Authorized Agent
1cC� IA!k
c
❑CW �w �`'""'
LIES ❑PTS
Affected
AEC(s): ❑ OEA ❑ HHF
❑ IH ❑ UBA ❑ WA
❑ PWS:
ORW: yes / r7 PNA
yet
Type of Project/ Activity
P i0 Dg c't' x
Pier (dock) length
Fixed Piadorm(s)
Hoadng Pladorm(t) '
Finger piers)
Groin length i
number
Bulkhead/ Piprap Wwffi
"g distance offshore
max distance offshore /
Basin, chuwW i
attic yards
Boat ramp
Boathwud Bol t
Beach Bulldoaing /
Other
Shoreline Isngth
SAV: rot sue yes
Moratorium:
Na yes o
Photos:
WaNM Aradmed:
y 12
/i � � • I Pi.i�7
(Scale: I"= r
q�H=
1H11
qN
■
WE
mole
q�
Nq
N
A building permit may be required by: Qne `4�4(i1 / t / n, L5 '
( Note Local Planningjurisdkdon) / ,
Notes/ Special Conditions ALl -
ar App i®nt Printed Name
Sig re "" PI a read compliance statement on bads of perm! it�7""
���� /A1
Appli adon Fee(s) Check#
❑ Sea rote on back regarding Rlver Basin rules.

�. CAMA / ❑ DREDGE & FILL JAL NU 78873 A B &�? D
NERAL PERMIT Previous permit#
New ❑Modification []Complete Reissue El 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 Q / ''7
J4,
�t AKkules attached.
Applicant Name �P �P/x P 1 s Project Location: County
Address �^^�— Street Address/ State Road/ Lot #(s)''�
w City A ,[p StatedGIr A-Ivf
Phone # 41Tn) 7 n 1-D70/E-Mail
Authorized Agent
Affected ❑ Cw ! qCW PTA ❑ ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / r, PNA yeses/ r
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) �.-�✓
Floating Platform(s) '
Finger pier(s) 7
Groin length
number /
Bulkhead/ Riprap length
avg distance offshore
max distance offshore /
Basin, channel f "
cubic yards '/
Boat ramp e
Boathouse/ Boatlift
Beach Bulldozing
Other
M
Shoreline Length !to 1
SAV: not sure yes
ppp�ggq I—.__
Moratorium: n/a yes 1
Photos: y
Waiver Attached: ye n �—
A building permit may be required by:
( Note Local Planning jurisdiction) /
Notes/ Special Conditions Al
or Applicant Printed Name
Sure **PI a read compliance statement on back of permit s
igf 0), 10/ 7
Application Fee(s) Check #
Subdivisio
City Sfcqps zip
Phone O (� River
Adj. Wtr. Body Ana/man, n,�,/unkn)
Closest Maj. Wtn Body —� a C—lo.�_s_.�LC�
(Scale: 'i I
❑ See note on back regarding River Basin rules.

AGENT AUTHORIZA`t`IOW FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ��r ��5 � c v re 1 SGQ
Mailing Address: 4 I % ruS vevior Or -
� /V C ? l5
Phone Number:
Email Address:
I certify that I have authorized
J
xedfe
Agent/ Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: /20 mo U'e V 1 -sf, 0 � 49, k16 /
at my property located at
in County.
l furthermore certify that l am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
C VIGt r ( PS (6i t r e� SG b1
Print or Type Name
Title
_3 / "S / a (
Date
t"d a 00
CA-4/or7-
R F C EIVFI)(
f HAD[\�I A lozl \
t/\.+ri'�"rl{{r�gtw� 4J1� i�F
This certification is valid through 3 / 1
S

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to e ci 's
(Name of Property Owner)
property located at 5 5. x F i;%�
(Address, Lot,
on Kr-,�,c%c ��,ciyrcI in _
— I (Waterbody)
0
The applicant has described to me, as shown below, the development proposed at the above
location.
t kl 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
,f,twH
(Adjacent Property Owner
Signqq{{ure* )) (
Prc{ctlPts .w lladrs t '�rr�tSoi�
Print or Tvpe N me
/email address
=' CF.IVED
'Valid for one calendar year after signature' (Revised Aug.20ANR 10 Z02.1
ACM-MHD CITY

I hereby certify that I own property adjacent to f h0 I �e 1 (U : e(-s c i t _'s
Name of pperty Owner)
property located at Is Sa P, 'fie �S f
ti (Address, Lot, Block, Road, etc.)
on cue Sc t� r l in %rrry Kon Slt4— c: S 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 till 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.)
I do wish to waive the 15' setback requirement.
= tl1 do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
UriP> tt(A
or Tvpe Name
rJ
Y. Gntq
UUM -
'Valid for one calendar year after signature'
&=IV[
(Revised Aug.2q)4) r c