72835D - bissette

'KCAMA / _ DREDGE & FILL Y wz.V� � � 3` No. 72835 A B C D
GENERAL P RM IT Previous permit # rk9 1.1 S O
❑New ❑Modification L Complete Reissue ❑Partial Reissue Date previous permit issued 83 f
As authorized by the State of North Carolina, Department of Environmental Quality f ��
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
❑ Ru s attached.
Applicant Name `liS r Project Location: County
Address Street Address/ State Road/ Lot #(s)
Ci State ZIP_��
Phone # ( )
E-Ma'
Authorized Agent
❑ CW
A ❑ ES
❑ PTS
Affected
❑ OEA
ElHHF ❑ IH ElUSA
❑ N/A
AEC(s):
❑ PWS:
ORW: yes f no / PNA yes/1 no
Type of Project/ Activi
u.,1A
Pier (dock) I ngth f X
Fixed Platform(s)
Floating Platform(s)
�x
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshor
Basin, channel
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulllldoo`zin
Other
Shoreline Length ' — (
SAV: not sure yes
Moratorium: n/a yes
Photos: y o
Waiver Attached: ( es no FT
X
A building permit may be required by:
( Note Local Planning jurisdiction)
Notts/ Special Conditions i I
v\ e- UZ
Applicant P ted Name
,-A
3 gnature ** Please read compliance statement on back of permit
t 11 C91?0
Application Fee(s) Check #
Subdivision
City ZIP
Phone # ( ) Ri erBasin }
Adj. Wtr. Body \ ^ 1 nat an unkn
Closest Maj. Wtr. Body
YV 1
Issuing
/,I qai
❑ See note on back regarding River Basin rules.

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: , L o 1. , T6 �S Mailing Address: Address: 3 f�C.L1 p (( 0 A.
Phone Number: D — 972 — Z/%
Email Address: h ► S S you.. r/� /lit U1 A I e ,_J k lcr1c
I certify that I have authorized o r s�
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: ,E"jt
S �oo A, IA- L di L
at my property located at
in h r-i,�S W; c. k- County.
(A "d
l furthermore certify that / 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:
I ] Sign ture
1n1, Lolt�s,—
Print or Type Name
Title
Z! I ! 0/
Date
This certification is valid through/�/

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL. MANAGEMENT
ADJACENT RIPARIAN)) PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: L(�tJ ► 5 ' e.-�-
Address of Property: --
(Lot or Street #, Street or Road, City & County)
Agent's Name #: i �. Maiting Address: ?d % �i
Agent's phone: Ii =. 3101�J Sacs (.��Z;C
I hereby Gertity that i own property adjacent to the above referenced property. The individual
anHwing for this permit has described to shorn on the aita_djed drawing-ttie t
they a�reepropostng.
Ibave Ito objections to this proposal.
I have objections to this proposal.
If you have objections to what is being propos" You mustnrrttify the Division Of Coastal N8nagement
(DCM) In writing within 10 days of receipt of this notice. Contact information for DCM offices is
avaiiabieat---- orbycaffing 1-M-4RCAAST
No rasnonse is considered the same as no obtection if you have been notified by Cartified Mail.
WAMR SWMN
I understand that a pier, dots, mooring pllings, boat ramp, breakwater, boathouse, or lit must
be set Hack a rno i► wm distance of 16 it= my area of riparian access untesss waived by me. (If
you dish to waive tfre setiack, you MUM i the appmpNar* below.)
i/ t do wish to waive the 15's&b=k requir'+errnOnt.%
I do not wish to waive the 16 setback requirement.
(Properly Owner tbfarrnation)
tc-AN-<
Wk
,5ionaftA
VP
�►m� am
Malting Adds
City/Stat&zfp
Ci to _ilx, -3,1 a3
Telephone Nwnber1 Eirmil Acidness
Date
(Rift rian Property Owner information)
gf ature-
of or,Typ Name
t
Mettfng Addfr"
i� c
Telephone Mur *w E-mail Address
Bate
(Feevised Aug. 2014)

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: L o I S a ti �6�-- '
Address of Property: # 15- u000&N�. 3&, L
(Lot or Street #, .street or Road, City & County)
Agent'sName #: i "ail. �,� �L.�t,,,4.�. Mailing Address: �1 O©1t�
Agent's {Tone #:1('� - �3 3� 013Jb�22 T _=y___Lo._
r
i
1 I hereby certify that I own property adjacent to the above referenced property. The individual
I applying for this permit has described tome as shown on the_a0phed dravvin the de ent
they are proposing.
Z_ I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify lire Division of Coastal Manag nt
(DCM) in writfog within 10 dayn of receipt of this notice. Contact Information for DCM offices is
availableati 1/MrMWACC0astatmatt rerbycalling1-88-4RCCAS'T.
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, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 95' 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.
1 do not wish to waive the 1 t setback requirement.
(Property Owner Information) (Riparian Property Owner Information)
Lou rs�tssca�t ;::!0W'-�
Signatu Sig are
•.
Print ar yFe Alamo 'tor Type Name
Mailing Address mailing,4ddress
C ty/ atelZlp Wswaop
�- - -
TeJophme Number/ Email Address Telephone Ni;rt tw Emad Address
Date
�RqviAug. 201411

Date Received
Date Deposited
Check From Name
Name o/Pam it Ibldr
Vendor
Check Number
ch.ck
amount
Permlf NumDenCommenro
Receipt or Rs/und/Reallocated
Colu—I
Column2
Co WO
Column/
Columns
Co/umnE
Column)
Column8
Column9