Thigpen, Reggie 77107C

KCAMA / ❑ DREDGE & FILL
GENERAL PERMIT
.gNew ❑Modification ❑Complete Reissue ❑Partial Reissue
c> 77107 A
Previous permit #
Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality / //1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (1 U,
Rules attached.
Applicant Name t J Project Location: County Gin,
Addresses W v� Street Address/ State Road/ Lot #(s)
City C,AA State ZIP_© [�
Phone # ( ) E-Mail Subdivision ` C�
Authorized Agent
Affected ❑ CW ❑ EW ❑ PTA .K"' ❑ PTS
AEC(s): ❑ OEA ElHHF ElIH ElUBA ❑ N/A
❑ PWS:
yes no PNA
B ( D
City ZIP
Phone # () g',r B
Adj. Wtr. Body 1 a" man'/unkn
Closest Maj. Wtr. Body A V
Sig ture ** Please read compliance statement on back of permit
94 1t^11 .V- 1 -74 a 4

DocuSign Envelope ID: 8AB277D7-E78AA880-AAC7-CDC2DEC6A913
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at 947 Chadwick Shores Dr. sneads Ferry, NC 28460
(Address, Lot, BI ck r�opd etc.)
on
Chadwick Bay -, in gneAds er'ry
-
(Waterbody)
Reggie Thigpen, Glenda Thigpen I
(City/Town and/or County)
N.C.
T applicant has described to me, as shown below, the development proposed at the above
to pion.
Ui 1 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)
RECFIVE®
, UN 10 NN
WAIVER SECTION �CM.MVAD CITY
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boat ouse, 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.)
�zl ( I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Properb,1_ ,Vner Information)
Vf Mi I -Ai �hV'
-rrnr ,-rr� M`)" '^1-rri
Signature
Print or Type NaMRri ce T. Taylor 7 r. ; Gregory
(Adjacent Property Owner Information)
Xv —fl �
Signature
PWroTypte�r-i n-f�a�ct
Mailing Address Mailing Address
943 Chadwick Shores Dr. sneads Ferry,NC 28450�"��S��Q2)
City/State/Zip 919-906-4241 City/State/Zip
Rio C1060
@ �7ppg umb / email address Telephone Number/ email address
6T 1�492U1U AM EDT
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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