63920_Jim Emmons_20190312

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t:: � /❑`DD;GE RE,r&FILL'-
GEN,ER�?►L. R'M:IT-; Previous permit`# N•
ew`. r �❑Modification ❑Complete Reissue" ❑Partial Reissue : Date,previous permit issued `�1 `
jAs authoried:by�tlie'State of`North.Carolina; Department ofi Environmental Quality
F andjthe Coastal,Resources Commission in an area of environrriental concern ursuant to 15A NCAC
]c Rules attached:
Applicant Name =� ,S Projeci Location: County;
Address ;/-:2/ -5:; h i� a _Off'- fl% Street Address/ State, Road/ Lot #(s)75rr 54,
Cit), , � `�•. --- State`�G'.,'ZIP--I- -i.ci /� w�' �JiL'� �v�S�• �c�
Phone'#)._-�t'7' 2.10.. �-Mail`- �.. Subdivision
'Authorized:.. eht:1 : - _Ci i-�'v2` iivi71'� �•;.:,
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- CW�' SEW' <,::. ,P.TA`�- 'ES���• PTS�' �Y
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�C7 ;-o �`o , 0 ,- Fhone"#� - River Basil. - U�.:
'Affected ` ('' )',
❑ OEA, ' ❑ HHF', -=O IH ❑ UBA ❑ N/A y ^,
AEC(s): Adj. Wtr. Body% :, f L� JC i' "(nat' /man /unkn)
o PWS:
i Closest Maj. Wtr. Body
ORW: yes / o PNA yes / no
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No
NONE
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--110
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Agent or/ARplicant Pri ted am
Sig6ture Please read compliance statement on back of permit
Application Fee(s) Check#
�GL zlJ _Z�
PermitOfflce 'i Printed Name
Qnati.Lre
Issuing Date Expiration -Date

t
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: I of E lvim D ,/5
Mailing Address: 2-13 -1g �1 g.F �,A I� l'c) A-
Phone Number: %9 --3 3-7-- 24 V %
Email Address: k'-) � On5 0 q tM a i L nVn
t certify that I have authorized
Agent /
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at ,
in
County.
I furthermore certify that l 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:
Signature
P. -E�M V'jS
Print or Type Name
Title
Date
This certification is valid through I I
' 0 Y W)LT:>
NZ- 2 �7-8)77

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that 1 own property adjacent to _ J I ryx Emrno V1 S
j y t (� ` {1+1 m of Property Owne$jt
property located at t D l � t li1Ct t`O I n VI& not — W -PJ I
on
G
it County)
1(a
The applicant has described to me, as shown below, the development proposed at the above
loc n.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION,ANDIOR DRAWING OF PROPOSED DEVELOPMENT
�lataalairedeae! pi®p®sing� tleved iarreasf raa2 s@ > !I las: s�rapt ®aa beP® or. 8fachi; s � dt4vii ag)
ew baaI-d.5 ci. run ner5 -�ar eyi+1 r6 P l e r,
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.)
�y 1 do wish to waive the 1S setback requirement
I do not wish to waive the 15' setback requirement -
JP erty Owner fo on)
i nature
Lt.1n�e5 � vnaYt
`Valid for one calendar year after signature
Property Owner information)
Mailing Address /s
E7%7—
Cftylstate;zip _
(33 2,14Z-oSJ1 / K�eS�y ll�iL �n'1Gl►%e(J/Ll
Telepho a Numberl email dream
-2i/q
Bate*
(Revised Aug. 2014)

N 10
ADJADMiRIPABIA- MMR]j gnu ROMM1
I IWSOY CW* 1W I GWA sty adiftent to j I YO EM VM 0-k Lot I to
pmp"toed St—�.—Of -it'll 'LO!MAn1Vm*a1P=- M-496WSAP-j
on b- M-5 Cre4,. (Addfm, LA Bil'O'cK, 1K, 0'.. "AM -a - 'K ty
In LLR-n8m N.C.
(CRYYTOM dfor Co")
The qVHcW has descdbed to me, as sliown below, the vc"14arsernt proposed at the above
VM I have no objecdon to this propel.
I hm ob**m to We propow.
'!_�D=- RIPTION AND=lp%mwlplo oF PROPOM D EVELMUM
-
W.
Q,` e� r ego., r - nAw bcards and runners 4r en-h k, pie
Mo I&P 'Wk
Wuj
0 Vey- YY"'4Vr6�adygcaA•-+ +0
VMS so
I urtdersWr4 tat a pier, do%, nmfing'Pubvil, bw MMp, brW&WRW' boom", INt or grain
ftwd be SM bit a mink num dhbnce of W from my area of riparian ass unkm waived by
M Of You wish to Mks the sett* you must InIdel the appropriate blank below.)
I do wish to Waive the IV sed*ck MquIremeM.
I I do not mft to *viva ft I V selbs& requirawrd.
Dafe* Ml q
[-,q t q -1 (RGYWdAU9. 2014)
.11

Applicant �', M M o y-) j
Date:
-General Permit*
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 im acts)
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
tem O impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount
W-�
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ FII ❑ 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 ❑
r
Dredge ❑ Fill ❑ Both ❑ Other ❑