Blue Heron Bay Community Assoc.

®❑(RAIVlA/ C1pREDGE &FILL NO. 75087
A B "'C D
NERAL PERMIT ,, Previous permit# '(
�ew ❑Modification ❑Complete Reissue• ❑Partial Reissue Date previous permit issued
As autho ized by the State of North Carolina, Department of Environmental Quality f�'�(
and the oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC-
} / ule/t attached.,
Applicant Name, (j 1 Project Location: County ! ' ,
Address Street Address/ State Road/ Lot # s)
City ', •, State ZIP • J 1 ��� ( ❑tC 1,')
Phone#( )(�./
�/� I_Mail
Subdivision
Authorized Agent - 1
_
1
City (l .!. l
ZIP
❑CW C]tw
Affected
L TA DES ❑PTS
Phone# (; 'L f�"11t^l ver Basin (�
LOEA L HHF
AEC(s):
rLJ IH` ❑ UBA ❑ WA
Adj. Wtr. Body
El PwS:
ORW: yes / no PNA yes / of
Closest Maj. Wtr. Body - -
Type of Project/ Activity
('_. l-,.t'
(r _-: �� l -� - 1 77 _
(Scale:
Pier (dock)length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshor
Basin, channel /
cubic
Boat ramp
Beach
Other
Shoreline Length ' A A J '
SAV: not sure yes t rho
Moratorium: n/a yes
Photos: yes o
Waiver Attached:) no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Condition; I
Agent or Applicant Printed Name
Signaturd '**'PleTeread'compliance statement on back of permit*'r
Application Feels) Check #
❑ See note on back regarding River Basin rules. /
i
Signatur 4 +
r
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: BLUE µC- V-p N t3 Ay CoMyylUtUl7� A s'sv(
Mailing Address: V)j Teuc pCT
NC-W?b4' , Nc- 2 KS l0
Phone Number: $ 13 - U c1 S -- S 2 `'i }
Email Address: �CM ('\S r 32 l
I certify that I have authorized A v�
Agent Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _ --is (')Y-� "y l_ i �_ T.
at my property located at ZLOC {-t E l;i M (�t R\j �_1 v1 e2 N
in CALTC 2 G T County,
l 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
Print or Type Name
ESiOEMN
Title
`l r 22. / 2olq
Date
This certification is valid through 9/30/19

I CERTIFIED MAIL RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Aaciress of Property
ay ark propcsing. A
—Ags2ntlorLor —drawing, 'Mill dimensions, must be provst ed with this letter.
you Must nofffy the Division of Coastal Management
!r,is n,0tica, Contact information for OCII Offices 1 .
S
orbycalfing 1-888-4RCOAST
- --a: 3_ 1,ztu !lave been notified by CerfffledMaii.
�Property Owner information,
SIvwlwk
IVAIVER SECTION
'--,1 ',reak.vater, hoathouse, or lift must,
ar. acces
s unless waived by me, (if
are bftarsK —1jov7.)
ag a r Property Owner Informatior:
-�Iie Nl.innber,EmailAddr ess
7F/9;, EmailAadress',
"'arc
(Revised Aug. 20 14}

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: _jdoy` NAY k. )0V)o%A-6C%
Address of Property:
Agent's Name #:
(Lot or Street It, Street or Rbad, City &
Mailing Address:
Agent's phone #:
f� jl hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
x they are proposing. A description or drawing, with dimensions must be provided with this letter.
I ` L I have no objections to this proposal. I have objections to this proposal. Q
5Cif
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 http://www.nccoastalmanaaement.net/web/cm/staff-listing or by calling 1.888-4RCOAST. �*
I' No_re_s_ponse is considered the same as no objection If you have been notified b Certified Mail. i 4I- WAIVER SECTION J
n Q I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must � k
(� `7 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.) T
I do wish to waive the 15' setback requirement.
W� I do not wish to waive the 15' setback requirement.
°r j
(Property Owner Information) (RiparianPropertyOwner Information)
Signature RCA Signature
Jo4)nnsj K • .JC,41r'1 S '6A NSItLttk Ind . C7C d%t
Pr nt or Type Name Print or Type Name
lot Ptl,cykn C1r.
Matting Address
14kUOu<l , INK 29 STO
City/Statoaip
(%IS)-4gS Slcil >/Iohrl 1 nK'3Z1
Telephone Number/Email A dress C nG1, t
0-1 1 eq- ( 2 01 `t
Date
idl z6v C dd-.,)
Mailing Address
wit) "o,A— �
City/State/Zipry
a26c2 -c A3 - O �r1P
t6�M Telephone Number/Email Address
Date
(Revised Aug. 2014)

Styron, Heather M.
From: David Anderson <[e-mail]>
Sent: Friday, July 26, 2019 11:57 AM
To: Styron, Heather M.
Subject: [External] Blue Heron Bay, Slip #8
Attachments: scan0096.pdf
Hey Heather!
I've attached the paperwork needed for the CAMA permit at Blue Heron Bay, Slip #8.
Please let me know if you need anything else!
Thanks, have a great day!
-Kendall
David Anderson
President
EZDock Solutions / Nauti Metal
5568 HWY 70W, Suite C
Newport, NC 28570
Office: 252-773-0793
Cell: 252-764-1234
Fax: [phone]
www.ezdocksolutions.com
www.nautimetal.com