61653_Pier, Platforms_20170901

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Applicant
Gerierai- Permit
Descf7be below the HABITATurbanaes for the application. fit values s�ot�tit *ph4he name, and units.o¢ eneasuremeri4 .
D(S7Ul ' YPE
.Ifabltat- Name -Goose On®
:,
TOT- AL _.F_
(Appifect.foK .
Disfytr ce iOiai:
`
i.i I.. es arty
'artttcip#tted
restorattan or.
telinp inipa
FMAL Sa. Ft>
(ilrtffcipaf¢d final
drsftatk rrcg.
6�edgd ariy--'
restoration .
•anarteitip'
: itnRaat art#nunt}
TOTAL ---Fee
(App ed for. •
DWturbance
total irtcWdeo
arr1F a�tic�paied
restoration ur
ter"rm "-impacts
F1t�L �e@� f ..
(q ipa{eif$rtal
dis lrtiarice
Exdt4r §: rGx '
iesigCti.aadlor
temp'iriipai
artiount
'Dredge Q Fill ❑ Both -.0 otherffi
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N:
Dredge ❑ Fill l Boni El Other- Q .
-Dredge. © FEU Q Both 11 •Otire�
Dredge C1 F`dl ❑ ' Both CI Other ❑
Dredge ❑ .ff ❑ =Both Q. Other CI
Dredge L7 Fdt 0. Both• ❑ Other [I
Dredge ❑ Fill E3 Both I] . Other Cj
Dredge Q Fig 0." III' Ot rep i]
Dredge 0 t ip Q Both El other E3
Dredge ❑ Fill (] Both �( Other Q-
©fe_dge 0... Fill 0: Both 13 Ottrer LJ
Dredge EJ Fdi-1 Both E1 Other El
Dredge i] = Fill Q 'B4th pther- i]--
Dredge Q 'Fill f� : t3otFf �} Other [) _'
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�GE�I�,,7' R��P�ARWN RROPERTY OWNER �A'ATEM��3
I hereby Cer* that ! own pniperty adjacent
p'op_"J located at fiji 7 �` ,! `' 4 V i� l�•�L•i Cf�(iL �1l.Jl.� f�/' �l��f/'a iCXJ 7
i (Address. Lot, plock Road, etc.)
on
(Walserbody) (CitytT andlor o unm
The apptrcatnt 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.
DE-4AX IM AND/OR DRAWING OF PROPOS® DEVELOPMENT
lmf+'dUWIMPOV1ffg development must fill in descdptlon below oraliech a sift drawing)
01
X . LJ j..L-t 2.C..1� • Ck�P72z, f 1 . .z L�7
WAAfM SECTION
i understand that a pier, dock, mooring pilings, boat ramp, breakwater, -boathouse, liift, or groin
must be set back a minimum distance of 1V from my area of riparian access unless waived by
me. (tf you wish to waive the setback, you must initial the appropriate blank below.)
f i do wish to waive the 15' setback requirement.
i do net'wrish to waive the 1V setback requirement
(Property Owner information) (Adjacent Property Owner Information) .
on n n �t n
R_R.
Pliat or- Type Npe
%_ iln,,-X 2) v2 -
Mail' Address
-cam Ci A-)
Telephone Numberl ems<7 ad ess
Date
02 017
=Valid for one calendar yearMW signature*
Jo
rran !VaRfu r
Mali Address .
CORta a p
-yq
Telephone Number/email address
(Revised Aug. 2014)

-1--y cernry inat i own property adjacera t'O
[groper=y located at `z' c' L�
's
l74� /iou �lQ/Y!
on -; �,� ` in �1310ck. Road, etc.)
(Waterbody) %r_�".�7c
(City/ own an
dlbr County) . N.C.
The applicant has described to me, as shown below,
location. the development proposed at the above
.i
1 have no objection to this proposal.
(Nance of Pron rtv rT
I have objections to this proposal.
DESCRIPTION AND/OR pRpWING--------------
tlndttfiduat OF PROPOSED DEVELOPMENT
Fr *Pasfng clevelopment must fill i►y descriPtIon below or aftach a site drawing)
understand that a pier, dock, mooring SECTION
roln
must be set back a minimum distance of Pilings,
fromQmy aat trea of riparian breakwater, boathouse,
unless warie�d b
me. (if you wish to waive the setback, you must initial the a ro rlate blank below) y
PP P
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)
Z /ix
sa®ems '�41
Si lure Si ah .e*
r-
Print or Type Name Print or Ty Name el
lip
Ma1Wg Addees, Mailin Address ,
City/Stete/ZiP r � 3?/State�2ip �/, v _ /
i
Telephone Number/ a ail address Telephone Number/ email address
Date Date*
(Revised. Aug. 2014)
*Valid for one calendar year after signature*

Spivey, Kelly
From: Cheryl <[e-mail]>
Sent: Wednesday, October 18, 2017 9:17 PM
To: Spivey, Kelly
Subject: [External] FW: CAMA Application for Platform Extension
Attachments: Scan0007.pdf
The attached receipt of payment was September 1, 2017, not 1917.
From: Cheryl [mailto:[e-mail]]
Sent: Wednesday, October 18, 2017 6:15 PM
To: '[e-mail]' .
Subject: FW: CAMA Application for Platform Extension
Please mail the permit to our Arizona address shown below. Thanks for the help.
From: Cheryl [mailto:[e-mail]]
Sent: Wednesday, October 18, 2017 6:12 PM
To: '[e-mail]'
Subject: FW: CAMA Application for Platform Extension
October 18, 2017
Dear Kelly Spivey,
Attached is a packet of information for the addition of a 12 foot by 20 foot extension on to our
existing dock at 104 Dockview Lane, Washington, NC. I have attached the receipt of payment
for the permit issued Sept. 1, 1917 for our dock repairs, previous general CAMA permit,
PPPOA Architectural Committee conditional approval, and Adjacent Riparian property owners
statement. Please process our modification permit. Thanks for your help.
Cheryl Stacy
10710 E. Voax Dr.
Sun Lakes, AZ 85248
[phone]
1

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Spivey, Kelly
From: Cheryl <[e-mail]>
Sent: Wednesday, October 18, 2017 9:15 PM
To: Spivey, Kelly
Subject: [External] FW: CAMA Application for Platform Extension
Attachments: Scan0007.pdf
Please mail the permit to our Arizona address shown below. Thanks for the help.
From: Cheryl [mailto:[e-mail]]
Sent: Wednesday, October 18, 2017 6:12 PM
To: *'[e-mail]'
Subject; FW: CAMA Application for Platform Extension
October 18, 2017
Dear Kelly Spivey,
Attached is a packet of information for the addition of a 12 foot by 20 foot extension on to our
existing dock at 104 Dockview Lane, Washington, NC. I have attached the receipt of payment
for the permit issued Sept: 1, 1917 for our dock repairs, previous general CAMA permit,
PPPOA Architectural Committee conditional approval, and Adjacent Riparian property owners
statement. Please=process our modification permit. Thanks for your help.
Cheryl Stacy
10710 E. Voax Dr.
Sun Lakes, AZ 85248
[phone]
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