72163_Dock and Platform_20180731

CAMAID DREDGE'& FILL
G
ENERAL PERMIT
_C New Modification' ❑Complete Reissue ❑Partial Reissue
,'=As>authorllized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Applicant'Name—t'Y— te-
'
Address
City. � .,,, , 'i, �� State`;LI C_ ZIP 2" 7 S /'7
Phone # (9�)- `i S/S. - a -7 X-Mail
Authorized Agent
Affected ❑ CW ElEW ,iil PTA,, El ES ]OPTS
AEC(s): ❑ OEA ❑ HHF / El IH ❑ UBA ❑ N/A
o Pws:
ORW: yes / o PNA yes / no
N0 72163, - B C D
Previous permit
Date previous permit issued c„'Lk-� \
Project Location: County
;�Oules
Street Address/ State Road/ Lot #(s)��
Subdivision f51
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Agent/or Applicant Printed Name
„SignatureEleasereadcompliancestatementonbackofpermit
L>
Application Fee(s) Check #
PermitOffcPrinted Name_,
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Issuing Date Expiration'Dafe

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Tyler Kelly has my permission to install and build a pier, dock, or
boathouse that would be in compliance with CAMA, City of Washington, or other
agency requirements for a permit in the Bay Lake canal system. Construction
would be done from his lot 10 or address 504 Bay Lake Street,
Chocowinity, NC 27817
Warren G. Whichard
Date 7/26/2018

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to /-ter � A, -A,, J--v 's
(Name of Property Owner)
property located at o 1f � y �e�- Y�
(Address, Lot, Block, Road, etc.)
on in 14�1 N.C.
(Waterbody) (City/To n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locati 0.
�� I have no objection to this proposal.
I have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
_
lliidrvdualproposngdeYeloprientmus#firlin:. escraptionYbe_ loworaftach:a==i'tealrawrng
WAIVER SECTION
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.)
y I do wish to waive the 15' setback requirement.
I do not wish to waive the 15"setback requirement.
(Property Owner Information) Y(Adjacnt Property Owner Information)
Signature Sig_ature
ke
Print or Type Name Print or Type me G
A" LF 14, Sy S 4 6 v a )/
Mailing Afidress M ir�g Address
lI/C, 2 7�/7 ly d o pvy+n ; Ay/y, L!' . g 7 9-
City/State ip City/State/Zip
Telephone Number/email address Telep�ion Nu�ber email address
% -t AK" '/
-Dat Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to I It, ILl- + km&, s
(Name of Property Owner)
property located at 5d `� a�v 7
L Address, Lot, Block, Road etc.)
on C� , in Gh©�w/W7 , N.C.
(Waterbody) (CityITown and/or County)
The applicant as described to me, as shown below, the development proposed at the above
location.
x I have no objection to this proposal.
have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
�.s..
(Jn v dual pos..ing development must°fill i► alescr pfion: below or�attacti .;sIng drawing
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 Ish to waive the setback, you must.initial the appropriate blank below.)
1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sig -nature kI
e,
J,-,-
Prid or T� ype Name
5oK) .A LJ(z, 5 T
Mailing Address
Clwco„Jy,1i Al-6, ZAI7
Ci%y State/Zi l
t5C'L ^-7Lis -co
71
Telephone Number/em Yaddr ss
7 /ZS / /F
Date
Date*
n)
a3o✓ne-so Lw+;o5
(Revised Aug. 2014)
*Valid for one calendar year after signature*

Applicant:Ty L-6'0z ee'u'7
Date: 3 1 '7--1 2, v 11%
4General Permit #. --1 Zt 9 3 --1,?.
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet
Habitat Marne
DISTURB TYPE
Choose One
TOTAL Sq. Ft
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternimpacts)
FINAL Sq. Ft
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
ternimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
d? eri
4A./A,--L.Dredge
❑ Fill ❑ Both ❑ Other
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44j<9
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑