68521D - Adaire

�4CAMA/ -DREDGE & FILL '�-�Sl OJ�i� A B C CD PERMIT Previous permit#
nAew -Modification Complete Reissue ❑Partial Reissue Date previous permit issued
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As authorized by the State of North Carolina, Department of Environment and Natural Resources _7
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC CJ 1 ''�
R I hed
Applicant Name S . G a ','I ou
Address
City YA i* �n State ZIP a f
Phone # (%) 2 0 �ft E-Mail
Authorized Agent [)0,\AA
Affected �W XPTA ❑ ES ❑ PTS
AEC(s): r ❑ 0EA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW: yes //fio) PNA Hest /no
Type of{{Project/ Activity
0 1 !A k-7V inn
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshon
Basin, channel ,
cubic yards_
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other i
Shoreline Length
SAV: not sure yes no
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes
A building permit maybe required by: �� S Ol/1 K OUVt
( Note Local Planning jurisdiction)
Notes/ Special Conditions hn-e S �J bT Q V
Agent or Applica t Printed Name
Signature PIeasefefft-B" p lance statement on back of permit
00 101$
5
Application Fee(s) Check #
❑ u es attac
Project Location: County is ,W'I AA
Street Address/ State Road/ Lotr#(s)
(n3q IAwViAvtt_ iir, sLAy
Subdivision
city skCA oqt ZIP 3. 91-7 0
none # OW ) ' 35SZ River Basin Lt/wt6tf
Adj. Wtr. Body ;(AUC¢ Davy Cd(r�� K ( at lam)
Closest Maj. Wtr. Body WLAI
aV1 c� hN-r A OY1CP Mgt r b I^
(Scale: I I 1=3 () / )
1101{, ❑ See note on back regarding River Basin rules.
Sea 0 a fye I
Permit0 icer's Printed N e
Signature
h 01-7 2/6q kol
Issuing D to Ex iration Vate

• AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
• Ga
SMailing Address: \� epy I S S
I I\y( -7, c� q c,5
Phone Number:
Email Address:
I certify that I have authorized
(5ilr) 014ei
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Imo` i ro\f OVA4 5 -
IrP bt i IA
at my property located at
in 2 u t IA.)iC k County.
II A`
1 furthermore certify that I 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:
ignature
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Printlor Type Name
ncow\&
Title
�lDq_I ZO L
Date
This certification is valid through I I

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//� 11 NC Division of Coastal Mgt. Habitat Impact Computer Sheet
v
Applicant. S, �� A d j,�.Y D� Z
Date:
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
teem) impacts)
impact amount)
temp impacts)
amount
V V
Dredge [IFill ElBoth ElOther
;
2J
Dredge ❑ Fill ❑ Both ❑ Other
l o
0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0

WIRO
Date Received
Date Depwited
Cheek From Name
Nana of Parmlt Holder
Vendor
Check Number
Cheek amount
Permit Number/Comments
Re elpt orb
10/6/2017
Grice Construction
Nathan Brown
BUT
11558
$200.00
GP 68544D SF rct. 5044D
GP 68545D_ SF rct. 5045D
GP 68522D SF rot. 5047D
GP 68543D SF rct. 5043D
10/6/2017
_
Maritime Coastal Construction LLC
George Brady
CresCom Bank
2552
$200.00
10/6/2017
I.P. Norton
James Faircloth & Ira Norton
BofA
8648
$200.00
10/6/2017
Backwater Marine Construction
Robin Craver
BUT
3064
$200.00
10/6/2017
Cape Charters LLC
IS. Gay Adair
I BofA
1078
$200.00
1 GP 68521 D
SF rct. 5046D