63165_Install 12' x 16; L-Head Platform_20181003

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GENERAL: "PERMIT-
Pril permit
•
-- New Plllllll6clifi��iol Reissue
El Partial Reissue Date previous permit issued
As authorized by the State -of, Nbrih-'6rolil Department of Environmental Quality
and the Coastal Resources Commission in an :area ofenvirofirrental
concern pursuant to 15A NCAC
LE Rules -attached:
Applicant'Narne Z W? L. L-,
Project Location: 'County 'E>,aAi-Y
Address,2_Li
Street Address/ State Road/ Lol OTT
City I 7r !_l State. 14 e__ ZIP `L-7 9 7 21 5 —T2,
Phone 4( 'E-Mail
Subdivision, 002
Authol A&nt
City ZIP -
Affected qCW EHll TA ES El FTS
rm El ES
e asin,
Phone yRi'' r. B'
E] OEA' El Ill - 0 UBA 0 NIA
AEC(s):
Adj. Wtr. Body r��Ah,il an (unpn
L J�
11 PWS:
l yes. i� no PNA I yes q-To
Closest Maj. Vytr. Body e' c2
. . . . . . . . . . . . . . . . . .
all
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■
M
M. M.
ME
Agent or App
licant Printed Name
167
Signature Please read comp il statement on back of permit
Application Fee(s)' Check#
PermitOfficer'l Printed Name
Signature
7 j 1 ti rL ql?)t.
Issuing Ill Expiration Date

AGENT AUTHORIZATION FOR CAMIAA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
Phone Number:
Email Address:
.? I s'
11-11
- Z I/ ie ktc,
2, dew_ �D.,
tA1 PTktc_� ,-.L
9Z9 CpIZ 2-PS-J
I certify that 1 have authorized 4, / 1
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:P�-
r�t� t�
at my property located at �' �� de e4
in F,
eao 4''�- County.
1 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.
Property Owner Information:
SignaturiV
Print or Type N me
Title
l I z9 I r/01
Date
This certification is valid through I t

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ` / i 1�-���''` 's
' (Name of Property Owner)
property located at 6 2`
1. ' (Address, Lot, Bloc Ro d, etc.)
on , in , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc M
1 have no objection to this proposal.
i have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
'(Individual proposing development muss rill in description -below or aftach a sife. 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 you wish to waive the setback, you must initial the appropriate blank below.)
i �V I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property_Owner Information) (Adjacpo Property Owner Information)
01 qua _e A -
Print br Type Name
0-
City/State/Zip
"--V- 5�0��3�
Telephone Number/email address
Date
agnut re�S�.
Print�e N me C
_ ao�c,(-
Mailing Address .
City/StateiZi'u?t-SU Sl YO
Telephone u er/email address
qhlih 9
Date's
"Valid for one calendar year after signature*
(Revised Aug. 2014)

Spivey, Kelly
From: bob carlyle < poled [e-mail]>
Sent: Monday, October 1, 2018 7:24 AM
To: Spivey, Kelly
Subject: [External] FW: permit
Tim hemphill
Sent from Mail.for Windows 10
From: Tim Hemphill <[e-mail]>
Sent: Thursday, September 27, 2018 8:29:35 PM
To: bob carlyle
Subject: Re: permit
Mr. Carlyle has my permission to act as my agent in securing the permit for repairs/replacement of hurricane
damage -at 215 Ridgecrest Drive, Chocowinity, NC 27817.
Tim E. Hemphill
Sent from my iPhone
On Sep 27, 2018, at 7:52 PM, bob carlyle <poledriver2@,,hotmail.com> wrote:
Tim
Permit required for job but will be free
I just need a email giving me permission to be your agent on job
I hope to start next week but I am going to try to pick up storm permits Monday morning for several jobs
if you could send this email to me would be great
Ps
Even if you change your mind on what you want or who you might want to do it it will be ok I will still
pick up for you no problem
Thanks bob
awall
Sent from Mail for Windows 10
1

t
Applicant: •P r-1 I t_ s_
Date: 3 v�oti3�2 zv
General Permit* _ ? ,Z 4-,9 7
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)__amount
FINAL Feet `
(Anticipated final
disturbance.
Excludes any
restoration and%r
temp impact
Dredge ❑ Fill ❑ Both ❑ Other ❑
9 2 �-
i9 2 �.1-�
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 ❑ FID,❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑