IRP, LLC 88540C

° JAMA ❑ DREDGE & FILL N9 88540 A a OC
Prervicim;
ENERAL PERMIT [)ate previous
ous permit Issued _.
),New ❑Modification 0Complete Reissu Partial Reissue
As authorized by the tojgtl North Carolina, Depar rave of Env ince"nal Quall m Ceas W Priourcat Comnassion in an ww of enWoranental concern Presuae tw
t $A NCAC _.> ..13 ��-a.+.4d— O Ruks utached, U Gam Pettnrc Rules mlabte at the f iON401 FrA.
Appkcant
APecced ®cw I_J�Ew PTA
I—
AEQx)r nOEA L 'IRA i-1uw
Type of Project/ Activity
5horeltne Length _ `"7 i •.,..__
Access Lens h�-
Prer (dock) length
Fixed Piattorm(s) `: _
pr alwa location (County):
LOIES LI PTS Atli- WIT Body,_.-�S
[>IMA OPWS Closest Mat Wtr. Body
Floating Platea"(s) ""•'� __� r
I
Finger puns) �/•��
Total Platform area
Wane8 iPraP rengm ,.yj.Jv+�-,
Avg IstanceoHzhore.> _f` _,,.•
Max distance/ length _
uastn, channel �'
.. .....
Cubic yards
Roat ramp"
Boathouse/Boatfift
$each Bulldozing ===e
OthM
SAY obse ik
adpratorium n/a
Site Phctos7
Riparian Waiver Attached.
A building perrtubtsir i�g I
1
TARIYA"EUS"UEfER (Urde «+a)
See note on back regarding RHer Bacn
See additional notio/cwdieom on back

AMA ❑DREDGE & FILL N9 88540 A B 0
�w�ENERAL PERMIT Previous permit
Date previous permit issued
New ❑Modification ❑ Complete Reissue []Partial Reissue
As authorized by the (State�gff North Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
t
15A NCAC ' 1". ) IUD ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant
Authorized Agent -bi
Project Location (County):
City i&LV'PNJ�AMKU%!State
�7-7 ZIPIS1 stne
EmailI� / Ge IIY ►t�:�L�JiL1�iII LR �. I//City
Affected ❑eW ❑EW ❑PTA
AEC(s): ❑OEA ❑IHA ❑uW
Type of Project/ Activity
Shoreline Length '-T {
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platforms) —
Total Platform area 1�
ulkhla- iprap length hFflgH i II
Avg istance offshore_, y_��_
Breakwater/Sill --�
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed:
Moratorium: n/a
Site Photos:
Riparian Waiver Attached:
YES ❑ PTS Adj. Wtr. Body —N�
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
AND
TAR/PAM/NEUSE/BUFFER (circle one)
See note on back regarding River Basin rules
See additional notes/conditions on back
Signature `•PIe,,Tse read compliance statement on back of permit*•
��©
Application Feels) Check q/Money Order

Name of Property Owner Requesting Permit:
ttLP �LG
Mailing Address: _
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: GCr) Ckv , , r.. "_ - ,
at my property located
in Gct t_i r p+ County.
I furthermore certify that 1 am authorized to grant, and -do in fact.
Division of Coastal Management staff, the Local Permit officer grant Permission to
on the aforementioned lands in connection with and their agents to enter
Permit application, evaluating information related to this
owner
Tftte
i t
Gate
This certification le ♦_,;N

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
s
property located at 40�5 tct�.n.�; +r, o , (Name of Property owner)
on (Address, Lot Block, Road, etc.)
(Water body) in ICI ei own
N.C.
(City own 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.
uesctilPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing developraentmustfill in description below or attach a site drawing)
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of IS' from my area of riparian access unless waived by
me. (If you wish to waive the setback; you must initiafthe appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish
Owner
Name
Mailing Address
Fork M1i1 S .
Cdy/Sfate/Zfp
Telephone Num er/email address
the 15' setback requirement.
*Valid for one calendar year after signature'
(Adjacent. Property Owner Information)
srgnorrnure'"
J'l is 1Yll%eS i'h-�i�YIT�i i 1
Print or Type Name _
MadrngAddreas ^+
char to ttP c.<< 7 22tri
Qfy/StateMp
Telephone Number/email address
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
Property located at �}O Kenn (Nameofproperty0wner)
trca-t-c„-. of
on tHaareSS, Lot, Block, Road, etc.)
(Waterbody) j in�^ / ca r �-�rtcr� N.l;.
(wty own andlor 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 ANDlOR'' DRAWING OF PROPOSED DEVELOPMENT
{Individual Aroposing development must fill in description below or attach a site drawing)
I understand that a pier, dock moorinW�VER SECTION
must be set back a minimum distance ofi15' omomy areat a of npatianeaccess unless lift
must in
me, (if you wish to waive the seffiack you must initial the appropriate blank below.)
I do wish to waive the IS, setback requirement,
r i do not wish to arve the 15' setback requirement.
Owner Inf ationj
(Adjacent Property Owner Information)
�nyistate2�p
Telephone Num erlemall address
RValid for one calendar year aftersignature
SYgnnrtne*
AMA (y�\PPC3 eY.,,t�
Pidintor rYpe Nerne
Mail! A -L
c tamp
P
Telephone Number/email address
fi TO
(Revised Aug. 2o14)

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