Dodson, James 76615C

CAMA / ❑DREDGE & FILL
�. GENERAL PERMIT
New ❑Modification ❑Complete Reissue El Partial Reissue
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
Applicant Name
Address (G'
city
Phone #
Authorized Agent
Affected CW
AEC(s): ❑ OEA
❑ PW5
ORW: yes ;f no
NO 76615 A
Previous permit #
Date previous permit issued
Project Location: County `)/o-k
Street Address/ State Road/ Lot #(s) ✓/f
B CCl\ D
j l[ol eadbdivision
- City 0 of ZIP 6
_AfW kOTA _A 6 ❑ PTS Phone # () River Basin l
❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body `'&
nat unkn
PNA yes no Closest Maj. Wtr. Body i V e-X
Type of Project/ Activity
t C 0j--16'
.M
Scale: 0
c"' gyp' )
Pier (dock) length X
Fixed Platform(s) x
44AI—_
Floating Platform(s)
Finger pier(s)
i i
i r—
i ; i
-- -....
Groin length
u ber
ulkhea Riprap length
; ,
-
i ;
I i
—i -- -- — -- — — — - -
i
i € ,
avg distance offshore
max distance offshore
i
Basin, channel
-
cubic yards—
i
_
Boat ramp
Boathouse/ Boatlift
_t—i-
Beach Bulldozing
Other
i
Shoreline Length
SAV: not sure
Moratorium: n/a
✓®
yes no
yes
Waiver Attached: (yes'' no I— L
A building permit may be required by: ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
N I tes/ S ecial Conditions s
F
Agent or pplic t Printed Name Permit Officer's Printed
Si iature Please read compliance statement on back of permit" Signat re
v� (f
Application Fee(s) Check # Iss ing D to E piration Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to J amts Doasoo's s
(Name of Property Owner)
property located at 5 12,
W cnk (Jr.
(Address, Lot, Block, Road, etc.
on In+r6%.coas�al in JV % 5a)' , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat` igrS. I,,
/ Uj} 4 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)
%O re Gk; t` 0-1`
�� ek �s-I h elu�k c�nd etc-h'o�
o tout 1 Ic l� ea d 4 � +
Th c rf vJ; l 1 be n u
+VIC -Fogy+ o r,"+ o e- I A y o ,-,vt .
w\� l 1 Inc., ntc d-e� ,
WAIVER SECTION
N-c\J d<c k' k bo ar ds
dodc-
eNIICh.A J
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' seiback requirement.
(Property Owner Information)
cJ(Amts Oodson
Print or Type Name
I pa Bo551-J00d C+
Mailing Address
eUrN C, A7S I
City Stat /zlp
k919) G-1� —���$
Telephone Number
y i ao / aoan
Date
nt Property Owner Information)
Print or'rypb Name
"i P 0e
Mail" g Address
City/State/Zip
Telephone tV mbe
Date
4l YVOCW NtkV2012)
�)r,M' -MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to , ) 6, r�—n "S --, s
property located at '5 1 cr-k T(-,xJ c Q N (Name of Property Owner)
(Address, Lot, Block, Road, etc.)
on WrAcnasi'a(
(Waterbody) (C , 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)
PC36W(A -43 eX "S-t "(A
Jock 4VAVJ 40(J- 401,A(-VX<,
1w-(- W'11 lot ou C'I\DAc 4-o -1he- 40+P("'r)+- Of- 1AYbQA--
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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Sigrr«t twe
cTatrle-S Do dson
Print or Type Name
/oA fsb'sswocy—A C4.
Mailin Address
nely I
cityrtate'( 0
919 ) 6A
Telep-hone'Number
q / 2 0
Date
I -)A 1")
Print or Type 1,4arne
'5- )-e-" te r4d
Mailing Address
Cityls
Te/eptionp Nu/ bar RECEIVF-tJ
Date
MAY U 6 lu(-u
(Revised 611 IP,01 2)
DCM-MHD U