71215_Thomas & Kathryn Hill_20181025

CAMA / 3'DREDGE & FILL
GENERAL PERMIT
XNeW ❑Modification El Complete Reissue El Partial Reissue
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
Applicant Name — v o'
Address t II (eA vi-11) E !U � C
City rA,44�&Al State K t- ZIP 211g2 J
Phone # E-Mail
Authorized Agent
Affected ❑ CW/ X EW Z PTA M ES ❑ PTS
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes / fib- PNA yes / d
N271215 B C D
Previous permit #
Date previous permit issued
1 H I I, c_:, -74,-
Rules attached.
Project Location: County (2A M i>&-n1
Street Address/ State Road/ Lot #(s) SR 112(o
In GSM 1) Enl ,blip 7�1L1 r:
Subdivision
city oAM k) tti ZIP z I
Phone # ( ) River Basin Isl,� t v7�A1 I
Adj. Wtr. Body 41W CP W Iq k nat /man /unkn)
Closest Mai. Wtr. Body ICi uL+�
Type of Project/ Activity ICf-,)1,-LICC-" (kdz142 AAlO RC.'S r ANI) AX212
i E. X 1 ilJ t< r i rr. A) 4'1(A X h jS 6-- = lot (Scale: Iria�� )
Pier Cdock) length
Fixed
Float
Finge
Groir
Bulkl
Basin
Boat
Boatl
Beacl
Othe
Shore
SAv:
Mora
Photi
■■■■■■■■■■■■■■■■■■■�I\■■��■■■■■■■■■■■■■■
Platform s
■■■■■■ME■■■■
EMEMMEMORNMEMEME■■■■■■■■■Platform
■■■■■■■■■■■■■■■■■■■■■
■
■■■■■■■■
■■■■■■■■■
cubic yards_
ramp
-1 Bulldozing
®�I®��%■�li�`'��•�`
�'��'��
-��=��iSr'_T-'?-�=.�T�U■���/i�ri�1.����4CiiTL
torium: yes no
jV PAL �LKttNAr7
A building permit may be required by: /y11)f N ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions 0157ZIR-16 0e,6 /414) X ZL�
Permit Officer's Printed Name
A� L-6,
Signature
lges
25 Ott19
Issuing Date Expiration Date

NC Division of Coastal Mgt, Habitat impact Computer Sheet
Applicant:jj j!-1 Permit #7/z-/5�9
Date: ©c-7 Z �Zc�f3
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 Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
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
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
StierYL��E
Dredge ❑ Fill ❑ Both ❑ Other ❑
5144
f1'
Dredge ❑ Fill,® Both ❑ Other ❑
pZUU
/
�Tl L 9
Dredge ❑ Fill ❑ Both ❑ Other �(
�v
ai�'j/'
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 ❑
252-808-2808 :: 9-8884RCOAST revised:0:2/x03/'18

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to s
(Name of Property O ner)
property located at 119 awl tm 'P .
n (Address, Lot, Block, oad, etch 7
on . in '/ V ., N.C.
(Waterbody) (Ci y/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc�on.
1 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)
i�
Ole
Gay a�,vv roe -
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 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Adjacent Property Owner Information)
Print or Type N me L
/ i '1 C AE,✓ - 4
City/State,Zip -
.rz- ,ICI - el-ig/
Telephone Number/email address
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 rA g4 KCIAbivIA 's
I (Name of Property O ner)
property located at l `'I C. CA *% Af . V",
(Address,
on in
(Waterbody)
Block,
►/ �[,.�y, N.C.
own and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
G 1 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
)6&- J'�
jgx�Kl?b5 IBM�RSQ '� 0'. e .
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.)
! ' LC- I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
r Ow er�ati (Ad' cent Property Owner Information)
Si torture S * tulle Y
Print o[r`�Type Name Print or Type Name
Mailing Addre s Mailing Address
City/State/Zi City/State/Zip
75 �. �f�- y977 as -'), - 'D
Teleph ne Nu ell/ mail address Telephone Number/email address
Adz /'%
Dat Date * L G
(Revised Aug. 2014)
*Valid for one calendar year after signature"

?77777777�7

Thomas & Kathryn Hill
119 Camden Ave., Shiloh
T , r-Ow'.
77
1 40