74672D_CARLSON, Anne Living Trust

CAMA / ' DREDGE & FILL No. 74672
A B C4, a
�G,ENERAL PERMIT Previous permit#6PbL! 4It Ph1,o1(51 sr .
k New Modification Complete Reissue n
Partial Reissue Date previous permit issued i /r ,ri/I ,i �
As authorized by the State of North Carolina, Department of Environmental Quality ))�� /0/IO/O8
and the Coastal Resources Commission in an area of environmental concern pursuant to I 5A NCAC C1 rl . 1100
❑Rules attached.
k Applicant Name i ti11 . 1•Ca.t 1.S.v1 Ll yi 0 en IruSt Project Location: County Ni IN t-(alit(iv{{'
Address 1 m Pi j A•v Vtt'tL Street Address/State Road/ Lot#(s) 70 oc
City UVt I Vitt r19 bil State AI t. ZIP 7434-I( Pi rte AlaiLt
Phone# (- ) 210- 0114 E-Mail N IA Subdivision J
Authorized Agent J 0 k[n Kl VICity 4ti, (1 I-L(11 C) IO11 ZIP 2-0 41 j
Affected ElCW ❑EW ❑PTA 1 :ES XI PTS Air'I" Phone # (110 )214-Dour River Basin Oa kQ
Ott O
AEC(s): ❑oEA ElHHF ❑IH ❑UBA El N/A Adj. Body d d Li SGru/ �/
Wtr. 1 •Mtn a /man /unkn)
❑ PWS:
ORW: yes no PNA yes / no Closest Maj.Wtr. Body A I ti,VV
Type of Project/Activity N 4 S4 71At, vT k1.e.IN f it 0 ' (A4 Oal 11 1>A_t k t-e u Q !art w u f41 (1
Cucl-A l vNt•I(a i1 cis. (Scale: )
Pier(dock)length ! i , ,iI. II
Fixed Platform(s) 4 I I / HI
FloatingPlm / '(Finger peiI / / lJ ■■ Kalil"
Groin
length
number „y •IUIiiiflII! I' IDiII!I1IIII!
1length j 11! '.
avg distance offshore 6/ 11010111111111111111111111/Pl1110111lw1111`Mii�i/R®RRU11RU/ANRRU
max distance offshore p' ' �ni,i� varnuaapiii,miplipumn I
Basin,channel I
1 111111E1111111,11111111115111111111111
' '
cubic yards 11111
]ii� Or! 111111
Boat ramp J
117
Boathouse/Boatlift
pio' r
Beach Bulldozing //�� `� '( III
Other (i 2SOC S-t j (G 0 't ,oL 'I al��©�a��i ii
r
� r i
, '
Shoreline Length 41- i4 D i i
SAV: not sure yes ii
Moratorium: /a yes no � Ill /I°
Photos: yes 1. t 6 ! y -
i Waiver Attached: es, vvno (lr �,� ' : \, V-i�1t ■�
A building permit At maybe required by: ij Q to4-14(..vt lv e r Ve' r- See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions 01 H .I I 00 ow 61 lui (o/al f 5iil fr/ /d ht c)-,(Qtlumi "-f N1-9 AA) k:-XI-ti.v t hui
ii i 111 r1 l Of tmif 1 AM d c cta tVi o1 l fd
0b 40, „\\ C-rrur I A p ea a S
Agent or Applicant Printed ame Permit° is Prin d Name
,) .
Signature\. *Please read comp) nce statement on back of permit** Si nature r,--,--,
1 L --1 9 u/ 4 /1 10/ pl
Application Fee(s) Check# Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: (Mk) E C Rk L
Mailing Address: A\ U
01:1ATIQGTDO ) NC Z89II
Phone Number:
Email Address:I certify that I have authorized JcFI,�1
Kv �Cr
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
I r
necessary for the following proposed development: MI V_X CA. 1-60
k)bb71=►0
at my property located at J)5 r ��
in la) }-AIONECounty.
I 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:
V")L
Signature
/
Print or Type Name
Title
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT,`l I hereby certify that I own property adjacent to , V t CARLO1 's
QQn� ;;-��;-111'� ^, ' (Name of Property Owner)
property located at 8 W YaJV E AF
/ (Address, Lot, Block,MI, 11.4 ��
on 1I�1A0 khl)JA , in , 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:WC
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
it iGs
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 do wish to waive the 15' setback requirement. ,r� 1
I do not wish to waive the 15' setback requirement. •-1v
(Property Owner Information) (Adjacent Property Owner Information)
� . e
Sign ure 1-12CM-3—
(.5 C (.79�Ito V1/ ar 6 CC'i.M x-r-n
Print or Type Name Print or Typb Na nip
'cos (9 c . 13c Co
MailingAddress Maiin Address
*/ C 2 R St/I kA) 101( ,-i-o--cl C „V,S4C2 4
City/State/Zip) City/State/Zip .J
Telephone Number Telephone Number
Date Date
(Revised 6/18/2012)
I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to (EVE. CAV L3OJ 's
Q� ��� A,��
on .�-� ��� lr (Name of Property Owner)
�j "C>
property located at �l
(Address, Lot, �• k Road, etc.
- Al , inDrt� , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
\•U 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 site drawing)
br P V WIIJ G
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 do wish to waive the 15' setback requirement. ,_„
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adja ent Property Owner Information)
a/tLIJ (14",i)//1/ -
Si re Sign e 4
(,) , r' CrfJo , ar �L .Sor� u
Print br Type Name Print or Typ Name
7�10 S- /° ,-�r r4�� 5 ,� 7(/' i '?n )14 anorbr•
Mailing Address Mailing Address
City/State/hipity/State/Zip
3 6 2/ o_J 77 336 4/5 /0`3 -7
Telephone Number Telephone Number
-�� ,ilk7 30 , 1 '
Date Date
(Revised 6/18/2012)

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E.Cmwnau9h,Jr..PLS,certify t0et this Plat was drawn under my su0orVisian hem en I.B.M.Jones.Jr.,PLS.certify that Ms MAW.,en this plat was dram,under my su00*010^hem on
id sunny mode under my sups from M=rt,ion 00 Zed Mason: that foal(rod eervey mocN under my super from in/onnatwn 00 000M harem: that
epics rat soMyea or+Nro y and Isad 00 fleshed lia; flat tM redo Me Davin ow net svrgy0I qs dwq and at0J as eafhad 1*,; that be mtio
oakuble0 s 1:10.Onat end!s con*b tM last of my.bn00909e e!precision es a mumy o is 1:10.0nat ones t to and
Oast e!my..ledge
I. Nateev rrry 0 *Signature.t/cenw Numb,and Seel and WAsl. habeas my original Signature.livens.Number and Seal
—day e! _ AO.Ma. EXISTING CONDITION SURVEY its I2K doy of fld AO.201,
TOR STEPHEN C. CARLSON I�� �.., .��GARGes lie. `Ce O�gO..Y..PLS NC M.Jo Jr..PL yN
l-NZJ AND IWE NC Liewwe Ne. L-1971 SEAL
ANNE H. CARLSON L p'T
�M 4
NARNEIT TOWNSHIP-NEW HAhtl1E'R COUNTY-NORTI1 URO!/It1
SCALS 1' 20'SOUTH SEPTEMBER
2008
RENSEO:.MNf4sRY JI,2019 i0 SHOW STAKES AND MOT/SET ON 50(/TIi LINE FOR ft/[MIFM PLACEMENT AMC REMOVE CONTOUR LINES AND SPOT ELElMi1C1NS
w SOMME110C0 L MOO
20 0 20 AO BO tmo
GRAPHIC SCALE-FEET -ran

• Check
Date Received Date Deposited Check From(Name) Name of Permit Holder Vendor Check Number amount Permit Number/Comments Receipt or Refund/Reallocated
Column,' Column2 Column3 Column,' Columns Column6 Column? Column8 Column9
61132019 $teDhen and Mn Carlson Mn.H.Carlson LWino Tnrst Wells Fargo Bank 27591$ 400 00 GP#74672D CS rct.7932