Melbard, Ryan 77310C

AMA / El DREDGE & FILL
G NERAL PERMIT Previous permit# A B CC
D
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 qnvironmental concern pursuant to 15A NCAC
les attached.
Applicant Name C°'� 't cY Project Location: County e
PP 1
Address"�O/�
1 e c/L 1 f Street Address/ State Road/ Lot #(s)
City State / V CZIP
Phone #-Mail Subdivision r�
Authorized Agent City mot, ZIP J
Affected DES ❑PTS Phone # () Riv r Basin
OEA ` r] HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body r%` �'� nat /man /unl<n
❑ PWS:
ORW: esno PNA yes n� Closest Maj. Wtr. Body cJ
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s) y�
Finger pier(s)
Groin length
number --
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse Boatlift -
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes in
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes 69- —
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Sp ial YCoditions I
Agent or Applicant Printed Name
cy4
,'/r yovteJr, CA
ISiu e Please read compliance statement on back of permit
U S 403113165
F lication Feels) Check #
(Scale: /j /j f )
-4—
�� ❑ See note on back regarding River Basin rules.
1 r A K c r s` U-1 C-' )
C 1,{ ,,
Perm70cje�Urintecl Nam
Signafia
h A,
Issuing Date ExIliration bate

A DJACENT RIP,813JAB PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacentto RYA14 a
Name of Property Owner
property located at 10 4 -J,
(Address, Lot, Block, Road, etc.)
an
Po �Atr cAA-remT co. Mc-
z A
(Waterbody) (C Ity/Town and/or County)
The aDollcant has described to me� as shown below. the development proposed at the above
iocation.
I nave no objection to Inis propasat.
I nave oojections to tnis prorjosa'
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Ifidividdal proposing development must'fill in description befow orattach a site drawing)
WAIVER SECTION!
I understand that a per; dock snooring pifings, boat ramp. Dreakwater, boalliouse, lift. or groin
must be set back a minis urn distarice of I 5'from my area of ifcarian access unfess werved b-v
rne. (if you wish to waive the selback, you must Initial the appropriate blank oeiowj;
-- I do wish to waive the 15'sot oacj( raquiregrant.
Idoriot .wisbrowafveine,(D'setsacs reauiremes-i,
(Property Owner Infoyma#oq-,.?
sienalur-
7elophone Numberl entail address
(Ad)acent Property Owner Information)
0 In
Ito,+ 109-CS
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