Scarafoni 72354 FLORENCE

0061A1 Mit\\lb 1*19
6 LAMA/ ❑DREDGE & FILL N_ 72354 A B C CI
,GENERAL PERMIT Previous permit#
.c A
) New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous perm't is
As authorized by the State of North Carolina,Department of Environmental,Depart
r
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC i�JC.( 1 ' ,$ ,..41,-. L
uleS a .died.
Applicant Name q1‘ S C_Q rA 0 s Project Location: County , J
Address 5 ita lick, ,A. e `��-Street1Address/State Road/Lott#(s)
� T/
City ` , State Al P ZI Pn i q lig Li A. S4.
Phone# ('/U) SI- SSSS E-Mail Subdivision \— R �j
Authorized Agent (,LA ( f(q!M City (c-t-Q�T�v'(l1t -C4CIn ZIP 7_1.5/86
Affected ❑CW KEW [IYPTA ❑ES ❑PTS Phone# ( ) �Riv�er_Basin /F-
AEC(s): ❑0� ❑HHF ❑IH ❑UBA ❑N/A Adj.Wtr. Body QM S CJALkhrV-4( .$a/unkn)
3❑ P s: ►'YY� A(S
ORW: yes no PNA yes / no Closest Maj.Wtr. Body
Type of Project/Activity Q()I Q P, t!G QT S
I _ y(Scale: , — a )
Pier(dock)length
Sti.�; Y 't'\ t
Fixed Platform(s) j. t �/'� r
Floating Platform(s) • ✓L$ ' K " .vi 4 + �' ••••••••• ...=i1...Finger pier(s)
Groin length
number
A h1 1 W
INI.- 52.
Bulkhead/Riprap length I .i.
avg distance offshore po
Air
max distance offshore Mann '1 I - `
I 1 i41 %S
fp
Basin,channel 4 ,
it)),
Kit1 —
cubic yardsi/r.e'''''' i
�(___ III
kg"(
Boat ramp ..,.../. t
Boathouse/Boatlift "`
Beach Bulldozing
I
Other 1
1
Shoreline Length (2) 50, If" ' ,"
SAV: not sure yes 40IIIIIMIFIIIIIIIIIII Ire•5illi ..7:111111111111 �
Moratorium: n/a yes0traVallu%„ _�_t„ W—*&
Photos:
Waiver Attached: 0 no
A building permit may be required by: (' c Ue $.e&CJ.. . I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)�p J �/ _ '
Notes/Special Conditions to Ie QI(1 Soo Rti c �( 0 .(, . r CV"CI
IGCa ,s,.(44_ .S exc el .
l ?),,--ooks S`'\5,44/0
Agent or Applicant Printed Name PermitOfficer's Printed Name
7-(PP (15-,I7-41..._ ......._....16
Signature////``' ����PIe///fie read compliance statement on back of permit.* Signature
k./...)c ;•re..d f1 t8 9/Z0i1`i
Application Fee(s)
Check#
Issui Dae Expiration Date
4

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of PropertyRequesting Owner R uestin Permit: ��� OSSn r�
Mailing Address:
)1/4 `A 0\Gt. ki
Phone Number: ©AO-S S 5 1"
Email Address:
e �c..�.�, v\.\
I certify that I have authorized r. i s st
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ht-p
at my property located at -L\
in Ni--\-1 U`,-,,1- "
County.
I furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Prpp4rty Ownetr informa ion:
Signature
Print or Type Name
Title
to l \. I
Date
This certification is valid through I I

. .
1 . . . . .
cER,n__eittuim_kLumito.RECEJP_ • . .-. 67E0
- • - . ..
. .
. :.
., .
olvistoN OF COASTAL.MANAGEMENT- • - . .
ADJACENT RipARIAN PROPERTY OWNER WYPOCiAtONMUMYER:FORM
Namept Promty Owner: •c• e-ow\ --" c.,,_,L.-cca.-. cal"
Address of Property: gp.. I \-14-1-tr` S-I- \ i '. la ‘4(,1-\ iVC, 70k1
(Lot or Street#,Street or Road pity 8,County)
Agent's Name ft: 'il-Pf,
_.-:..
Agent's phone#: CAI c.__ _ ) _
19 .-_____.__.:l )_A ._1L \a-)...0 f".\1_ - ' '...."
-..,_,..._
1 hereby certify that I own property adjacent tothe above-100On*property: The individual
applying for this permit has described to me as shOOn'..-On.theethu*atisitnwkia#10-14eV*010.111 -: •
they areip roposing. ' a;stria 'in 0 dr- n., -, th dl:-.i--1:-J 4 ra':il.be kA., •.,:,,,,. , .:(11i' •; e: • . .:-•
. . . . .- . . . .
.. "• .. - - - -
I have no objections to this proposal. -• '1*".9bocticiiisio this-proposii
,. .
• .. ---- - --- • .
, : . . . - •. . - . -
. ,
If you have objections to what is being proposed,YOU mustndfilly.*DNjalou otcOasAll, Mai.lagenl.ein OM in ..-... •
writing Within la 40 of,"reoofpt of this nOtloit. CorrelipondattO0hoOkt barna aaditt127.Carclinal Orlin:3441 - -:
Wilmington;NC284064846; DOM representativoS can also*piing/4w at lotaj 104,7216.-iv9-rt*040 Is
considered ,same as no ob ectien if ou have been ritilifieil. :Oeitilti it Mak- - '-
.•. .- ..
WAIVER SECTION
I under _.
tand that a pier,dock, mooring plIjogs;break**,pearmuse,oft,or groin must be set
back a minimum distance of 15 from my ea*Of itt!#4ia40eas unless waived by me• Of You
wish to waive the setback,you must initiattheapprdpriate:biank 0.0004)
•
Ido wish to waive the 151 setbaCk reqUirerneal
1,40 tiot wish to waive the 15'setback requirement,
... /7
IFtriformation .
ay. v.tteitv 6viner Information
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SiSi .n aliire
Si: ., lire
Prirg Of Typo Name Pfilit orType Pbme
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ilelfillipgAddress :
'Wag Acklress
City/SA(04
City/State/Zip
T: :,. ono Number
/
16 - ti - 1
Date
Date'
Revise.41 6/18/2012

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