72512A_Rodney Perry_20190103

-� � C'AMA / ❑ DREDGE & FILL NO. 72512 ® B C D
GENERAL PERMIT Previous permit#
ANew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
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 I SA NCAC V4. I 100 '. -4 H L
X] Rules attached.
Applicant Name
Address k► .
D,,111 c,,)
cA -1ro,\
City 5a,Al�r,.
Shur<1
State N(-
ZIP a-:ySLIq
Phone # Dl1013 S 7'4
E-Mail
Authorized Agent
M \1 S�u�n.�
F c r 1-4,
❑ CW
❑ EW
X PTA ❑ ES
41PTS
Affected
AEC(s): ❑ OEA
❑ HHF
❑ IH ❑ UBA
❑ N/A
❑ PWS:
ORW: yes / 1!b,
PNA
/ no
Project Location: County be, i t
Street Address/ State Road/ Lot #(s)
Subdivision —
City S�„i1.. .. s hoc t ZIP A :+g 4!9
Phone # ( ) River Basing
Adj. Wtr. Body Cr,, ► Jo lc.'- C3..,k e k (nat an unkn)
Closest Maj. Wtr. Body u K S o..d n J
Type of Project/ Activity e �I Do t. e Y2c ; It- ,
(Scale:
Pier oc ngth a l �' X Lj'
Fixed Platform(s) j
Floating Platform(s)
Finger pier(s)
Groin length
number
C8(lfhiprap length I
avg distance offshore��
max distance offshore
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length } ) lb'
SAV: not sure yes
Moratorium: (1�) yes no
Photos: es no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
5p 4'1 1..-, r r-, 5 h'>r'_ i ❑ See note on back regarding River Basin rules.
Agent or Applicant Printed N
Signatur. * Please read complian statement on back of permit"
Application Fee(s) Check #
�U ►^ �. a 1
Permit Officer's Printed blame
Sign ure
1 /3Lgig s/3/ay�9
Issuing Date Expiration- Date

`NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant Pt r ( y Do tu� Permit #: • `� as
Date:
Describe belo'�t 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 ❑
Dredge❑ Fillp Both ❑ Other ❑
la
J�
N _ % -
Dredge ❑ Fill ❑ Both ❑ Other g
9 L
V
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 :: 1-888-4RC©AST :: www.nccoastalmanagement.net revised:02/03110

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
n
IJ�t H hc�_n
Mailing Address:
,? I S&Lnfl pa G� L'TAO '7 ?k, r
exrT-v /�4L,)Ie A) . 279 Y9
I certify that I have authorized (agent) Azt (- (7&),,L I A,t,1�J/ to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) QK rzn cry. b0e-KA -x -U0 A".0 & (- k
at (my property located at) ltJ �c )
Rj
This certification is valid thru (date)
Property Ownfq Signature
/2-//-20/ E)
Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to r
f.Xfz n 's
p ( lame of Pro erty Owner)
property located at 8l J! 11 0b(o ) &ry3 %jellT
(Address, Lot, Block, Road, etc.)
on ��ac S'�t 9 in 7Ciy`7``� /�`� N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: A7taJ-7A,J.Z- Mailing Address: 7
Agent's phone #: 2 r;Z -'62 -.26id'
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
� Zf Lr2 C ram- ,�>,)l k b� ,a, � 41t
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement net/contact_dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
A`r14Yw
ner Inform on)
I ----
Signature
Print or Ty0e Name
0 S. De Tr'� L
Mailing Address
icy /A� ,��.� . 1�y
City/S te/Zip
�SZ-2�/-aS7y
Telephone Number
�e, . /Z.
Date
(Riparian Property Owner Information)
Signature
�,�tJ-,74
Print or Type Name
22 S . Pa&c�&t\,Q ' �.
Mailing Address
mi= /,,J/l A).� - " i/ /Y/
City/Sta Zip
d6/- :?3/V 16
Telephone Number
Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION FORM
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
I hereby certify that I own property adjacent to ' C 's
p ((ame of Pro erty Owner)
property located at 8� �%; I j 0 �& Cz)W. 7,e/i z
(Address, Lot, Block, Road, etc.)
on 6a,, �7-ac /r- S&-)40 in <TJtM 1 1 c N.C.
(Waterbody) (City/Town and/or County)
Agent's Name #: I'r1l1�c 1 /'-�n•� rU Mailing Address: 2,
Agent's phone#: Z.%;z - ,262—,Z6Td' �i�ckl�i _ A/-U'T/y ;
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangementnet/contact dcm.htm or by calling 1-888-4RCOAST. No
response is considered the same as no objection if you have been notified by Certified Mail.
(P Owner infor tion)
Signature
Print or Tye Name
�)(r S' C6 `� c0:&J / Y2 L r
Mailing Address
rCity/S(bte2ip
35 7�1
Telephone Number
l Z -// - 201
( ri Pr t=
nformation)
Signature
,Ce.)7r C ��
Print or Type Name
83, S, Dv 6ce�2%33 i W r_
Mailing Address
/41�j /t) C , 2
City/Stat Zip
Z2
Telephone Number
12-l(-ZD1
Date Date