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Howell, Donald
-I CAMA / ❑ DREDGE & FILL O N. 78943 A B ch D GENERAL PERMIT Previous permit# W�New ❑Modification El 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 environmental concern pursuant to 15A NCAC I❑ Rules attached. Applicant Name L, "'f i) , ' f r ti v� I Project Location: County State IZ ZIP_ { Phone # ( l ) �7/- iG' E-Mail Authorized Agent Affected 0 cw . NEW M PTA ❑ ES ❑ PTS AEC(s): LJOEA ❑ HHF ❑ IH ❑ UBA ❑ N/A ❑ PW$: ORW: yes / no PNA yes / no Street Address/ State Road/ Lot #(s) /_ ! / (/ Subdivision % City ZIP Phone # River Basin //!/I ✓-- Adj. Wtr. Body �nat /man /unkn) r- Closest Mal. Wtr. Body A■■■■ ■■■■�■■■■■ MEMO■■■NONE �....::C C:MEN: .....: MEMO ■ MH■ OMEN C..■ :I■..■:;:. M...:: Now�■::... MEMEWINEM ME 0 SEE :;: MOS::EO MEMOS EM■■■■■ ME MEMO OE ■■ ME! ■::■ ;■■; ONN ■■ME■ ■M. 11MIN MEMO M;Ems O■■;;EEO ■;■. Ei :■� MEMO ■E:■E■■ ;.;. . ■■.ENN MEMO�■. l■0 Ef .....0®■■■■...■:E M■■■■■■ SEE M■ ■■■... • MEN ■E■■■ N M■■■E■� MEMOS ■ENS ■■■:■ EMS■■M.IN M■■■ MINES MOMMEM No M®IN MII M : ::: ::MINE ;;.;;;; ■:ME.■::11111:■MIME ■■..HEMEM Agent or R11 nt Prints, NZ e Signature "" Please read compliance statement on back of permit za Application Fee(s) Check# Permit Officer's Printed Name / Signature C Issuing Date Expiration Date l ENT RIPARIAN PROPERTY OWNER STATEMENT hereby certify that I own property adjacent to Uc utc�- N. %wWL l ' I (Name of Property Owner) property located at I I � ©a l�— Lq✓t '' 11 /� (Address, Lot, Block, Road, etc.) on _ W he EI eK- Gin eP� in SgPc Js R?rN.C. (Waterbody) (City/Town idd/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) �;F� ' �� D o 0 q,+" c�bQ 14 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// , a he setback, you must initial the appropriate blank below.) /A/ I do wish to waive the 15' setback requirement. I do not wish to waive the 15' setback requirement. (Property Owner Information) signro I d l l Print or Type Name I I q o a lc Lcl ri Mailing Address ..—s xi — Date r;// ,496 (Adjacent Property Owner Information) Signature Print or Type Name 1(8 Mailing Address S�,d, r�2y mac, City/State/Zip gel CP Ces- -7,79r Telephone Number Date (Revised 611812012) ADJACENT RIPARIAN PROPERTY OWNER STATEMENT I hereby certify that I own property adjacent to I Aald �ut,ip s III, (Name of Property Owner) property located at 1 �Arl ff� 1� �/ (Address, Lot, Block, Road, etc.) on wkeelm— (/�r�_,eelC, in <y§ J S ��rr�i , N.C. (Waterbody) 7City/Town an r 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) 0 a �k H n o 'e D 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) Si nature (J 1--6l,�� II Print pr Type Nine II`t dcLIG Lay1P M fling A dres 5av� s 'r t NG A wo City/State ' yr—i-'?VS-0 Telephone Number Date -- (Adjacent Property Ow�ne� Information) Signature Print or Typpe Name t 6 L1 C�a�c �"-tR Mailing Ad ress kA-nii b City/Statel7ip 3('U Ctz�j u5 fs Telephone Number _ `2-la kU Date (Revised 611812012)