52600D - Hatley

CAMA / DREDGE & FILL �60U-�
GENERAL PERMIT Previous permit #
New ❑Modification Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environment and Natural Resources
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 07 H , (2 O O
1 t/ ❑ Rules attached.
Applicant Name Rogtz t-t- A-rL r y Project Location: County 87"tis W 11 c K
Address 4 02 8L)6 AnJS VAtd.F_ y WA Street Address/ State Road/ Lot #(s) 4 `i Lc LAB
City CARy State ZIP 27513 --S-rfz r e. ;
Phone # ( -)AJ.1A Fax # (-) A11A Subdivision f/ /,1
Authorized Agent City Oc F_A,1 1 t m ZIP 7. V4 tog
Affected CW EW PTA ❑ ES ❑ PTS AC,G N-, Phone # ( 9 10) % U9 - River Basin [.-!w KQE a
L]OEA HHF IH TUBA JiN/A
AEC(s): Adj. Wtr. Body CANAL an /u (nat /t nkn)
u Pws: Fc: �
ORW: yes / io PNA yes / Crit.Hab. yes /0 Closest Maj. Wtr. Body ( w w
Type of Project/Activity kf_9LAcr-- WEST CANAL't pir-a RAMP 8r
uoA-r IAI 6 (�0 c V. 1,4 X is - L. (Scale: 1 0' )
ger (d�4� -
_ - ❑_.—
Finger pier �_i� t./ L.! L _ Nor-TH AN
l
Groin length _. T I
number - - -�
Bulkhead/ Riprap le h
avg distance offs re
max distance offsh
Basin, channel — - --- -
41
-144
f
cubic yards -
Ij
B)(t 19
' Tt C . �iw N W
Boathouse/ Boatlift +
-_- - -
Beach Bulldozing t
lu
Other
1 _ LA `
- /-��, I
Shoreline Length ± /200 t I (/�lvtl: l=Acl1 1
+...
SAV: not sure yes
Sandbags: not sure yes no
Moratorium: n/a yes rt
Photos: yes �- - _P �{ Q�
Waiver Attached: yes _
A building permit may be required by: TowAo( Or OcF_AN Esc c L�FAcN ❑See note on back regarding River Basin rules.
Notes/ Special Conditions O 7 N 1 2 O o A /V 1> A 4t- a T N F' f t t.Q C A 1_ _ T- A-
FEp-rigAt- R1=61LkLATiaA5 APPLV
Agent or Applicant Printed Name
i
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Signatur � Please read compl' ce statement on back of permit
/ ip 2, :, # 3122
Application Fee(s) Check #
y rz C Cis, rz ti
PermitOfticer's Signature
Issuing D Expiration Date
1;2/3t /.2018 5/1 /7-014

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date l Q
of Property Owner Applying for Permit:
Mailing Address:
0 4, jr Yc- L /-j
--7Y,3
I certify that I have authorized (agent) G % 1�
to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) /
(� b � O
at (my property located at) l / /,P-AhQ!
This certification is valid thru (date)
DU4"
Property Owner Signature
Date

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US MAIL
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISIO`` OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner:
Address of Property: 4 q LQ1
l
(Lot or Street #, Street or Roa(, City & County)
Applicant's phone #: Q I C1 _ 75L,3 Mailing Address: -1vto {�Oe,Cp S cczki_T ^d-`
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 proposing. A description of drawine
with dimensions must be provided with this letter.
6�11— 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 the Division of Coastal Management (DCM)
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the.same as no objection if on have been notified by Certified Mail.
WAIVER SECTION
I understand, that a pier, dock, mooring pilings, breakwater, boathouse, or lift 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' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property O er I fo mation) (Riparian Property Owner In rmation)
Sig `re 6
Si 7 a ure
Print or Type Name
Mailing AddrCss
City / State / Zip
Telephone Number _'\ 1 V (off o.oz. 4 S''
Date 1 L t Ct `-- 1 d
Print or Type Name
Mailing Address
City / State / Zip
Telephone Number
Date j'Z 1 l ?5
127 Cardinal Drive Ext., Wilmington, North Carolina 28405-3845
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanagement.net
An Equal Opportunity 1 Affirmative Action Employer — 60% Recycled 110% Post Consumer Paper

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U.S. Postal Service"
CERTIFIED MAIL° RECEIPT
Domestic Mail Only

Date Received
Date
Depos/ted Check From Name
Name of Permit Holder
Vendor
Check Number
Chack amount
Permit Number/Comments
Receipt or RdundR"Nocated
Column?_ _
Column2 _ Column3
Colmml
CohIM5
Columns
Column?
Columne
Colum1,119
12,312018
John Dixon
Robertv Hatlw
Firm Cita,ans Bank
3122
S 200.00
GP #52600D
TM r