73545D_VAVRA, Ron

,
0❑CAMA / DREDGE & FILL No. 73545
A B C ® ' •
GENERAL PERMIT Previous permit#
��—% KNew ❑Modification ❑Complete Reissue ❑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 15A NCAC U 4/1, joy
Rules attached.
Applicant Name Pot1 va vra Project Location: County New,Loneovei
} Address /ibol Fir 1(h ((re k R'd Street Address/State Road/Lot#(s)
' City w'(}M State NC ZIP a S4I 1 S`,vvv\;2
Phone# (GIIV ) 2ag'1314 E-Mail /On vfi tis'q 6717.e itStall 4 Subdivision
Authorized AgentSp((11 (llr` Nk 1' ht UC. City s otwv4..._ ZIP
❑CW ❑EW ❑PTA YES POTS Phone# ( ) River Basin r'V/1 if e a k
Affected AEC(s): ❑0� El HHF IH ❑UBA ❑N/A G1 Adj.Wtr. Body r C.f l (nat /man /unkn)
❑ PWS: p
ORW: yes / no PNA / no Closest Maj.Wtr. Body '1(WW
Type of Project/Activity gdpcsa) fC /frfC(E /!'I _fit 0'Qb" /V//1/
(Scale: I: D )
Pier(dock)length /►
Fixed Platform(s) I ✓ i.FF7 OCEEK rt. owb/`+�w
Floating Platform(s) i/1 pCA'i�, �s„�� �M ,)
Finger pier(s) i /FJ Is ��
Groin length M
1' c number I
CIEMZED Riprap length I OF IIIMIEFFAMMEMEM
avg distance offshore 0 , `�
f max distance offshore o ( 1 , i TrrUhCdQ 1 S � c I
I
Basin,channel I i
WAIN
,cubic yards i i- y i ' -
Boat ramp 'ii'� ��/ �_� U. -�
Boathouse/Boatlift -i%/Y An III_
Beach Bulldozing I"��1��1/�i -'"
Other as o sF 1�6 ��7 J
j mil
I ( ',
___
...
. ,
Shoreline Length ..iv,. ✓ liii i
SAV: not sure yes O M�_ r —1./
—:5
{L
,l e��
Moratorium: n/a yes 6 OS i i f dw
Photos: yes o P, ltY 1 ��0144,,
Waiver Attached: yes VAVR►► PR`FT.t1+( •. K ' P r
A building permit may be required by: Qiv it, , , ♦ I v Li See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) /
Notes/Special Conditions A f A /5 / ii ( .4 /) �o / - 0l , S A t. I
4Di ' QLh s GLI f rvq_c uN 07 sr cppm r /
Patrick An'1
�/f�it„ :vim,rY/C�`/ / (c)
Agent or Applicant Printed Name Permit Officer' Priinnn ed Name
F Sign ure **4 permit** Signature
Pleas
e read compliance statement on back of Q oo 1c 5/ ,J11 7/21/y
Issuing Dat Ex iration Date
Applicationee(s) Check# p

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: ?l 11 VA V
Mailing Address: 1 (90 ( Fc1TC t-1 612EE l- h-n
LuiL Il3G7o1.J , i---)e 2g4/I
Phone Number: R 13 ly
Email Address: (?-29l-)\JAV,2-4 bell H • v
I certify that I have authorized
Agent/Contractor
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 I60 ( FL i 4- aiLE K R .. Doi Lo-f/Ug7hlj,►Je ? ylII
in (u/-lA/•aou County.
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:
Signature
.c2-01 --) VA ✓gA
Print or Type Name
Title
Lt I 73 1 ICI
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �{-34L.D VA LiP-A 's
(Name of Property Owner)
property located at I 190 I FLriz n4 cLi 'j 97
(Address, Lot, Block, Road, etc.)
on f CTO -1 Cg€g , in t,c I (-D-f Kpa Io➢,) , 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 fill in description below or attach a site drawing)
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.)
I do wish to waive the 15'setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope ner Information) (Adjacent Property Owner Information)
Signatu• Signature*
AV V-ic - F't li
Print or Type Name Print or Type Name
120b C FvTe-t-I C' K
Mailing Address Mailing Address
(.v�L r`'l�l-76rT61f.�, 1•�L 28/1 / l,V Il.d Il 71oP) ? 14l
City/State/Zip City/State i
R to z�$_ L3r - -o 5G-3 �Telephone Number/email address Telephone Number/email address
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -)ALD VA 1/4/ 's
(Name of Property Owner)
property located at t bb I fiv tic I-1 a E AD
(Address, Lot, Block, Road, etc.)
on FVTC--- Q P , in WI L-t-iiii 1 7 k) , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
to tion.
e.--- I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
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.)
14 PI----rclo wish to waive the 15'setback requirement.
I do not wish to waive the 15' setback requirement.
(Prope ner Information) (Adja nt Property w er I rmation)
(_
Sign r Q atljje*
Y--)4LTD v a (�\KO PA tr lS Tx-
Print
0/A
or Type Name Print o Type Name
I lQO I Fu-re_4-1 oi2Es. j /525 FU`te I a 2e -7P
Mailing Address Mailing Address
lA)i I17oyJI J 28tiI wiLH 1i. '7rS01 IJC 2-$ilt I
City/State/Zip City/State/Zip
gI0 — ;-Z3 — t31-
Telephone Number/email address Telephone Number/email address
Darn Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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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 Columns Column5 Column6 Column7 Column8 Column9
5r210079 !SouN Cape Marine LLC Ron Vavra We/a Fargo Bank 1063 $ 400.00 GP k735450 PA rct 7347