74780D - Fischer

CAMA / ❑ DREDGE & FILL No. 74380 A B C O
GENERAL PERMIT Previous permit #
7New ❑Modification ❑Complete Reissue El 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 I SA NCAC Q- t . j'UU � 01 1-4•26G
❑ Rules attached.
Applicant Name J e- f �� ✓ Project Location: County T�
Address Street Address/ State Road/ Lot #(s) F d U
City inState.,j(— ZIP
Phone # (, �) La 9U U �� E-Mail �k Y�O e_b Subdivision
c= (�
Authorized Agent <,,, % J,, , L I, c.� City � � � — D c � c ZIP V e L1 % a.
Affected ❑CW NEW RPTA CUES 4-t7PTS Phone # ( ) River Basin Z,,,,.be —
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
AEC(s): Adj. Wtr. Body (na 4�/unkn)
❑ PWS:
ORW: yes /gyp%+- PNA yes kirrG� Closest Maj. Wtr. Body —A w
v
Type of Project/ Activity e 0 ( -, c_ PX 1 S �- s � = ' o c (c
Pier 1pnotb
Fixe
Float
Fing
Groi
Bulk
Basin
Boat
Boat
Beac
Oth
Shor
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Mor
Phot
Waiv
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t
ength
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cubic yards
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ramp
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A building permit mayX required by: TO-1
( Note Local Planning Jurisdiction)
Notes/ Special Cogditions nk�� ;(( (C -I• - cxWl��
Y\ Q5r Ir Mose
Agent or Applicant Printed Name
❑ See note on back regarding River Basin rules.
• tY( -s A C)I4 r V—Gr G11\
Permit Officer's
Signat ** Please read compliance statement on back of permit **
�' a °1 v-9`-
Appli tionFee(s) Check#
Signature
Issuing Date 1 Expira ion ate

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
')A .
I hereby certify that I own property adjacent to
property located at
6lae6'
I, 's
100
(('' (Address, Lot, Block, Road, .)
��[
on C ain t . N.C.
(Waterbody) (CityrTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location. 11
1--� I have no objection to this proposal. 0,4v ace W111 tl�
I have objections to this proposal.
L�t70(VN1'1 l � �
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill In description bellqw or attach a site drawing)
X G
WAIVER SECTION N
1 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 bye'"m�
me. Qf you wish to waive the setback, you must initial the appropriate blank below.)
s11 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property
Signature
Print or Name
PC)f ! �9
MAiling Address
(( ``,ct-r�e'�zhyn�a !.x—
Cy1 Dt- 1E10 Er`a
Telephone Number/email address
1b-4-A
Date
'Valid for one calendar year after signature'
(Adjacent Property Owner Information)
atu e
T
Print or TRe Name
f7ji"-1-5cJr�-
�Address ,
ti'q.--�4 G'4- 33
city
iG - .2 16 - :�.5" 3
Telephone Number / email address
t►�,71
(Revised Aug. 2014)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: _ � I've% � -: Spew -(-
Mailing Address: I'> C) + ��
Phone Number;
I certify that I have authorized H5 Construction LLC
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
__R�e. n 1401V►cv
I
at my property located at 1 \�4-1) 1�
in"'�, ounty.
I 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.
Title
Date
This certification is valid through 1 C I I � ='

X'
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to N.A �"Ee✓ cJ D--� ,s
(Name of Property O ner)
property located at / iL O
(Address, Lot, Block, Road, e )
on 0- , in 6 -Q'Lc�_s�r•� N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to rrie, as shown below, the development proposed at the above
loc tion.
i have no objection to this proposal. O_Ab� J WI1) l'Q
I have objections to this proposal. 140_14N'1Yt"1 9k�
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description belgw or attach a site drawing)
V
6 s
r A
WAIVER SECTION N 14
1 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 b .
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
on)
Signature _
loze Y'
Print or &pe Name
)20 13 ram# 13-9
M ling A, Jdress
1
Cit /State/Zi
�1
Telephone Number/email address
It)_ (:�'• R
Date
(Adjacent Property Owner Information)
6: _ .>
Signature* If
Y, RiiC-141. l70 H ill,%
Print or Type Name T
// 9 Al sy
Ma �g Address
City/State/Zip
33c:•air -ro9-2-
Telephone Number/email address
Date4
(Revised Aug. 2014)
*Valid for one calendar year after signature*

Date Deposited
Check From Name
Name of Permit Holder
Vetaloi
Check Number
Check
amount
Permit Number/Comments
R—i t or Relun&Reallocated
CWumsl
Coi—S
ColumM
Cokmnti
Colwm6
Co/urm7
Co1urm9
Column9 _
Allied Marine Contractors LLC
Curbs Corder
First Citizens Bank
7815
$ 200.00
GP 974763D _
Tmac rct. 9081
H5 Construction, LLC
Jeanette Spear
BB&T
2407
$ 600.00
GP #74380D _
BB rct. 7942 _
Warren Fischer
Warren Fischer
USAA Federal Sevin s Bank
1039
S 400.00
1GP #74780D
TP rct 9495
Allied Marine Contractors LLC
Richard Rose
First Citizens Bank
7728
$ 200.00
GP #71841
Tmac rct. 9076
Allied Marine Contractors LLC
Dan TaylorFirst
Citizens Bank
7809
$ 200.00
GP #71844D
Tmac rct 9077
Allied Marine Contractors LLC
Robert Evans
First Citizens Bank
7814
$ 200.00
GP 971806D
Tmac rct. 9080
F and S Marine Contractors Inc.
Am DeVen a
PNC Bank
8170
200.00I
GP #74548D
TMc rct. 8296