68652A_Phyllis & Jenna Doyle_20180214

{a,CptMA -
Q DREDGE & FILL g C D
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorizedby the State of North Carolina, Department of Environment and Natural Resources,
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC % I {f , l i L`[J
Applicant Name I llq `I" l 4C N&'� ( )t
Address 6 i I fl 1T,u
City `j"3LCIO State —a ZIPPhone # (a,) I �' , S� T- Mail
Authorized Agent (ni/y\wy -I1kII I.I4c,AlL-
Affected ❑ CW `ow C,y PTA XIES ❑ PTS
AEC(s): ❑ OEA ❑ HHF /❑ IH ❑ UBA ❑ N/A
❑ Pws
ORW: yes /ino PNA yes
i
Rules attached.
Project Location: County 171E
Street Address/ State Road/ Lot #(s)
Subdivision l)) q
City 1) ISCG ZIP
Phone # ( ) River Basin j)W, j ur j Aw K
Adj. Wtr. Body r XAL (nat /tCia':� Junkn)
Closest Maj. Wtr. Body j)ti 614 ( t cV <' ZU,vr i
I
■■■■■�Iili■■■■■■■■■■■■■■■■■■0■■■■■■■■■■
NOME
= liilA■■��R�rnr�lll.Y�■■■■■H■■■■■■■■■■■■■■■■■■■■
Issm
16h_��7�.r���C`■■■■■■■■■■■■■■■■■■�■
Eta
■w■MME■
M�
MMMMMMMMMMM
i
A
-.M�
JIMMERMOMMEMEMEN
ROMMKOHMSEEME
ON
MEN
Ross
■■■■■G�L��I■N■■■■■■tom\:�
■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■dill.\■N\\�6`�■■■■■■■■■■■
■mom ■ MEMO MEW. r.M■■Prdc"I■MZR■■■E.-94IIIIIILZRw■■■■■■
n■■■■■■■■■■■■■w�■■■■■E'nn
mom•■i���E■■■■
■o■■■■=■■■■■■�i
.MEMEM
■a■M■■MEE■■■■M■
MEMO:: : :: ■nr�n
■
mom
�ae�i■
y�� ■
Mill kY.f��■►!■
■
r
�/ /'>6.% C.
Agent or Applicant Printed Name
7TSignattfre •'Please read compliance statement on back of permit*
Applicatioh Fee(s) Check #Check #
I-1FIt)&/ i1AA: LJ(S
PermitOfficer's Printed Name
Signature
Issuing Date' Expirati nDate I

MC Mviislori of Coastal Mgt. Habitat trrapact Capyiputer 3hee4
Applicant: All/LLIS Permit#: 'Qq�5-z
Date:
A�
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)
Dredge ❑ Fill ❑ Both ❑ Other ,1
N
G/ICG>v/J
Dredge ❑ Fill Both El Other {�
/5zr' SF
15�cS�
J
5Publ)6
Dredge ❑ Fill ❑ Both ❑ Other
VOSIC
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 ❑
:?3;L��08.2su6 :: '±•Bsti-�6ew i;3BY' av fv_+nt�rget�asBa3_vnr�na @sad se2.nxQ revised: 02/e0.'W'1,Q

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date Zf ` lle
Name of Property Owner Applying for Permit:
Mailing Address:
J 9141 Si70pe M<<l 0,Aive
,�Ioeo r4 2 yid
I certify that I have authorized (agent) ( i N //� �( 4� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) Do6K ,
at (my property located at) L`�i
I-L 6O257 -I
This certification is valid tbru (date) 5 l� ! i
0
I
z/d'1,j>
Property Owfier Signature (/ Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own props adjacent to f �h• i s �� ��I�P s
�] ( me of operty Own
property Ineetad At LUU7 I , I � 2
(Address, L ,Bloc Road, eta)
on ,{%¢,L CU '�o�d in 2iS CcO N.C.
(Waterbody) (City/Town andfor County)
The applicant 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description below or attach a she drawing)
d
or.,
S 4,41 Qj20iJ
rr�Whlltlal �` f"� 6�`Ljl mr ICT
i
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' f(om 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.
4"r- I do not wish to waive the 15' setback requirement.
(Pxoperty Owner Information) (Adjacent Property Owner Information)
,M • rnrrr//or type rva e pp
pem r
Mallfr Address
3005b cilyl$Iatalzip
tS41—/_7,v—l1cAS
(Revised 6/1tf2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to CO (5'Dd C 's
Nile of Pr arty Owner)
property located at /_dl I �1 i I q 2 5 �z S 2a¢ LSOoWrz% np, V e
(Address, Loy Block, Road, etc.)
on �Aw lj cc) in I� LI N.C.
(Waterbody) (City/Town and/or County)
The applicant 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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must rill in description below or attach a site drawing)
1xKK�
'" '\ A a'k
a�1 0�l
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 16 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 16' setback requirement.
011� ✓ I do not wish to waive the 15' setback requirement,
(Adjacent PrMerty Owner Information)
Print a Na e
Mail'
n Addrgss
Dare
(Revised 61182012)

�\�}//§�
� � \//�
Q
> 6 $;yyi2 \\�y \Q` \\
\� ������� � � � ~�� ^ ^,