Gillette, Kerry

NCAMA /P DREDGE & FILL /$ N. Q �7O427
�. / A B C D
GENERAL PERMIT Previous permit#
LNeW ❑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 ���
f -�-{- Rules attached.
Applicant Name / !\ t' \ r Project Location: County
Address ! i (i ' f'r, / ,- f Street Address/ State Road/ Lot #(s)
City f / / State ZIP
Phone # ( )- �� r. t/G--' E-Mail Subdivision
Authorized Agent I'(7te� �`�l� f hC City <' �_ I� ZIP
1
Affected ❑CW _.FSJ EW j)I PTA };OES ❑PTS Phone# ( ) River Basin
AEC(s): oOFA ❑HHF OIH ❑UBA ❑N/A / 1
❑ PWS:
ORW: yes / no PNA ,yes / no
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number i
Bulkhead/ Riprap length's
avg distance offshore_
max distance offshore
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes no
Photos: yes no
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
,
i
Agent or Applicant Printed Name
Ad). Wtr. Body !/ t l (nat /fnan./unkn)
Closest Maj. Wtr. Body V
(Scale: )
❑ See note on back regarding River Basin rules.
Permit Officer's Printed Name
Signature "" Please read compliance statement on back of permit*s'
Application Fee(s) Check #
Signat re
Issuing Date Expiration Date

DIVISION
OF COASTAL
,LIEN
2� � �— 3 s( f �'; �.:f a fill j •' r�: r -�,
Name of Property Owner:
VIS
Address of Property: -7 I0 ( MOS Mal" th I (9^e f ��
(Lot or Street #, Street or Road, City & County) /
Agent's Name#: Y �T� NI ,�fe{�'Mailing Address: � l
Agent's phone g(ft)
I hereby certify that 1 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
theyareproposing. A description or drawing with dimensions must be provided with this letter
V I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notifythe Division of Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, liR 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
Signature rr
e,Vi"�l i l/�`•�
Print or T e Name
66 6WASIT
_
Mailing Address
GV04, may Ad,
(.
city/state/zip
Zelephone Number
� N
�
Date
(Adjacent Pro/ple�rty/ Owner Information)
I'/
Signature
Print or Type Name
Q?5 4 &. hopes
Mailing AcTdress
Al. Y / S-4//
CitylS(atelZip
( i� s) .- , r, *21
'Telephone Number
Date
Revised 6/18/2012

DIVISION OF COASTAL
Name of Property Owner:
Address of Property: �6Y144s, mt * ke, fftce,2L kjaf. A � ohs/OK/
('Loot or Street #, Street or Road, City & County) ✓
Agent's Name #: ��^�C�rNI Uld LK Mailing Address: y^ n
Agent's phone #a (� — c��— J�34-& e S' ate/ V ` r 10�`
I 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
they are prgposing. A description or drawing with dimensions must be provided with this letter
w� ///I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notifythe Division of Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response is considered the same as no objection if you have been notified by Certified Mail.
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.
4— 1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
X
Signature
Print or T pe Name
4�940 i^ r.�11/ I �h .
Mailing Address „
cy o
rn
ity/Sfate ip
a
L3
a1z
07ephone Number
o
v/�a3-�
Date
(Adjacent Property Owner Information)
Signature
ke-e-, Po )-�a►)
Print or Type Name
�� cnys z�- ,
Mailing Address
•C, X46d
rCittyy/SStaate/Zip
TeTeph6 — Number
Date
Revised 611812012

NCDENR
North Carolina Department of Environment and Natural
Division of Coastal Management
Pat McCrory Braxton C. Davis
Governor Director
Date la 97_ i 1
Applicant Name
Mailing Address
-t,
Resources
Donald R. van der Vaart
Secretary
I certify that I have authorized (agent) 6'e i 4- J I ue/e-K to act on my behalf, for the
purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity)
,C, O)k"y
This certification is valid thru (date)
Signature
o.✓ N
400 Commerce Ave., Morehead City, NC 28557
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.ne;
An Equal Opportunity \ANirmalive Action Employer
at (location)
RECEIVED
DEC 2 3 2019
DCM-MHD CITY
NorthCarolina
Natyrally
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