Heath, James 76392C

9CAMA / U DREDGE & FILL No 76392 A B D
GENERAL PERMIT Previous permit#
/141�ew nModification UComplete Reissue 1711'artial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality /p /1
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC - 0 711
Rules attached.
Applicant Name J �S Project Location: County_ 0119
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Address 1 Street Address/ State Road/ Lot # s
City 5'21✓ - _(' ._. _. State - ZIP_
Phone # 0112)71 f�_- E-Mail �yl, A41--e rl4 Subdivision____
Authorized Agent - Ciry_ _ ZIP t
Affected - ArCW '" `EW -PTA -�M ❑ PTS Phone # (_) River Basin
OEA ❑ HHF Li IH U USA f l N/A
❑ PWS: t
AEC(s): Adj. Wtr. Body —(n unkn)
S.
Closest Mal. Wtr. Body — ✓�� to i ' ^ L
ORW: yes /� PNA e3 Cl
no
Type of Project/ Activity
r
(Scale:'
Pier (dock) lengthAl
00,
Fixed Platform(s)
Floating Platforms
,rx7--
Finger pier(s)_ —
Groin length
number RP L
Bulkhead/ Riprap length
avg distance offshore . RPL it') / pqe
max distance offshore
Basin, channel
cubicyards--
Boat
iBoa[ho St' Boatli(t x
Beach Bulldozing
j -'L�
� vie!it A
Other (yl
_..
V
lc�
Shoreline Length �
-yow
SAV: not sure yes n
Moratorium: n/a yes
Photos: yes — - -
Waiver Attached: yes _ _..-_'-_- __._.___%�-- ---TT-
A building permit may be required by: j� Wj CO
See note on back regarding River Basin rules.
( Note Local Planning jurisdiction) I ( 1 1 1 - 4
'T- 11 r 1
Agent or Printed Name (7 � le_ �h - -- - ---- �� ism �jAe (l
8 � PermitOflicer's Printed ,
Signa e i Pie se rea complian to ment on back of perm) Signture
plication Fee(s) Check # 2-1mxp lion Date
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2 7 Anl 2 020
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Brix M vS 14 1 / 2 s
f �] (Name of Property Owner)
property located at 2-7j ���� t� r W ar
_ (Address, Lot, Block, Road, etc.)
on in S ea5 FP 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 fill in description below or attach a site drawing)
J �-c 0l�-feecAeal PfaWikl�
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 dp tiNish to waive the 15' setback requirement.
I do not wish to waive the 15' setback reauiremenr/
(Property Owner Information)
/gnat ure
CAI'11 e S 4,
Print or Type Name �}
Mailing Address
City/State/Zip
%/0)512-1603 4arne hcai6a&enfailC�%E''
Telephone Number/email address
t <-1t 61
Date
"Valid for one calendar year after signature*
(Adjacentproperto#nek Information)
Print or Tvoe A16rae r,
Mailing Address
City/State/Zip �-
Telephone Number / email, address
ED
Date *'
(Revised\�A�g. r0�1420
{Nl
CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to La " e s 4 , lflF% l,' �h 's
(Name of Property Owner)
property located a; .2 r a nel% 2 W Or
/ (Address, Lot, Block, Road, etc.)
on ,� (, �'(, in .' 'reads F of/-k ,fall yI u/ Gcetofu, N.C.
(Waterbody) (City/T n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to titir.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
S,e e, g f (C, C A *eol fifa W/ nl
REr,C Pvm
MAY U 1 ,_,Zo
WAIVER SECTION DCIW.MHU GJr
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.
(Property Owner Information)
tgnature �f
t/ Gt
Print or Type Name
75 6 andyiew Or,
Mailing Address
City/State/Zip
��f r�A�11S4C11Z�� Ca `.�
e ephone Nahlberlemail address
�rlV )a/ q
Date
*Valid for one calendar year after signature"
(Adjacent Property Owner Information)
AZ14Z��- �— -
S gnat re *
/�© Ze Y
!2�� U N Type Name /r
-
Mailing Address A/ C r LSD f r' r ,
tty/State ip
Telephone bet"/ email address
3d - Q,e 7 R E((;FJ (FD
Date
(Revised Aug. 04)o -I zoo

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