64342_Gary Respass_20190531

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:.:., CAMA/ q DREDGE &:FILL .'-': ' 1--'.- - ' ' ' ' ' ' , 'no:, --/LLID/ ''-' ' -
X• - - ' '-: . -' - •. - .-4-P4104814R •- '— A S
c.., • GENE - - A L''' PERMIT -. : ' .,:. - , ' — : — ' ::. „._.
Previous permit# ''-,A)//A-"'":"--• - -'-
'''' ----) R.T4NeNAr-- 0 Modification ' OC:OmPleter Reissue ' DPartiairReisSiie bate previous permit issiled f\)./11
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As authorized by th&State of North Carolina;Department of Environmental Quality . .
and the Coastal ResourC4Cornmis5ion imin area Of environmental concern pursuant to I 5A NCAC
' • , ' :, pilules attaFhed,, •., , : : ' .. :',-',
0 4.1:100-
Applicant Name' 6.--ATV - RE-Sf A..5t.: , .Project Location 'CountillE tA j'.7c.)-g._ — --'-- . -''
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Address c/!-II I bt p :. - q ? • R P. ' ' ' Street Address/State Road/Lot#(s) 0 2:0 te.r).'5:•S' - ' ': i'.,
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City 17AAii-7,7C.,61 : .: • : - . ' :§tate AK ':ZIP ',1'7 Po 0; )29 E 177 7
Phone#-(*)4441;.3165 -E:Mail •--- Subdivision p055 Amp :,
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:', • --. " s,a Affected dvi' AW 'gPTA ';-' ES ' IltiaTS , ' Phone# ( ).61 C-/Lt-5 105 River Basin FA/41-;),C-0
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Shoreline Length 60 n I 1) , I I : 111 11111EP
Moratorium: n/a yes
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Photos: 'es . .
Waiver Attached AD? no u
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A-building permit may be required by: gf--Aulf oA-r .couirJni . I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) —
Notes/Special Conditions , .c r;r., (57 FL i lob )7EMI r r 6,AM DOA/S
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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to &QC / I C�Sp4v S 's
(Name of Property Owner)
property located at $' 0 OS 5 IA t3c1\_ II cR 'IS c 2 ,
(Lot,Block,Road, etc.)
on PcLVY,. \ CO V 1 V ,in ,N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below,the development he is proposing at that location,
and,I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
/ I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
x
4_4Z •OU2
t ji
Signatuf
Lt3 y11I i.so
Print or Type Name
2 �a`? _ qq5 - 01 I l
Telephone Number
Date: 5 - q, „ Z O !9

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Gorj F4,5e945 's
(Name of Property Owner)
property located at 8�O r oss I o4, i\LL o2.788C
•
(Lot, Block, Road, etc.)
on arrl,i,e_o ,in rEaV\ ,N.C.
(Waterbody) (Town and/or County)
He has described to me, as shown below, the development he is proposing at that location,
and,I have no objections to his proposal. I understand that a pier/mooring pilings/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
-_ - waived by me: - -- — --- -- — - - - - - - -- -
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
S' a e
e/k4)E7`ti �.d4( l t e
Print or Type Name
Telephone Number er
Date: oC(-(/- /f

? ei,r1)?.(2/xrus-
AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: CrQ. I, e o& eSp)��S
Mailing address: .5) "Li 1 0 d 9? ' l
a1A -ego) Ni-. Ptry a
Telephone Number:
- 9 9y - .3/Ds
5
I certify that I have authorized S14o Lcv'ksc on To(--(agent/contractor),
to act on my behalf,for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at 1 2O g SS /Pd AA- /ye
This certification is valid through (date).
(Property Owner Information)
3,1yeZ4• '-cc,014--t,
Signature
G-nh�( �. esp�sS
Print1 or Type Name
Title, co. owner or trustee for property
\Syny'
Date

Telephone Number
• p
� 1/ rrs-
Email Address

•
Applicant: &ARY. 1-`" S
Date: 31 /MAY Zolg.
General Permit#: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
TOTAL Sq.Ft. FINAL Sq.Ft TOTAL Feet FINAL Feet
(Applied for. (Anticipated final. (Applied for. (Anticipated final
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Habitat Name Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or temp restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
YDRGe(ki ' Dredge❑ Fill }- Both 0 Other 0 ICO F-1 20orr
SFIAtLew oT7 Dredge❑ Fill ft Both 0 Other ❑ . two°Fr z 7d0 of-
Dredge 0 Fill 0 Both 0 Other 0
Dredge 0 Fill 0 Both ❑ Other ❑
Dredge❑ Fill❑ Both 0 Other 0
Dredge❑ Fill❑ Both 0 'Other ❑•
Dredge 0 Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both 0 Other ❑ •
Dredge 0 Fill❑ Both 0 Other 0
Dredge 0 Fill❑ Both 0 Other ❑ •
Dredge 0 Fill❑" Both ❑ Other ❑
Dredge❑ Fill 0 Both 0 Other ❑
Dredge 0 Fill 0 Both ❑ Other 0
• Dredge 0 Fill❑ Both ❑ Other '❑