69016D - Bazemore

-. :CAMA / DREDGE & FILL
kaENERZ PERMIT
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Previous permit #
W
ew Modification ❑Complete Reissue ❑Partial Reissue
As authorized by the State of North Carolina, Department of Environment and Natural
and the Coastal Resources Commission in an area of environmental concern pursuant t
Applicant Name ��s)"�i�ca�
Address 2 �/ a e4 I00
ACity I�. State ZIP
Phone # E-Mail
Authorized Agent p 10 V g let
Affected ❑ CW XEW XPTA ❑ ES ❑ PTS
AEC(s): ElOEA ElHHF ElIH ElUBA ElN/A
ElPWS:
Agent or Applicant Prin�d Name
G
Signature "Please read compliance statement on back of permit **
Application Fee(s) Check #
Date previous permit issued
0
Resources �J (900
1 SA NCAC
❑ Rules attached.
Project Location: County IZ 4.1_nAJ j(n
Street Address/ State Road/ Lot #(s)
H0-7 s h o (t Iire T)f.
Subdivision
City � L!(( Vt ZIP
Phone # ( ) %--% I _c� River Basin Lvr4 6CIA57—�
Adj. Wtr. Body '�l wVx,(,fit /man /unkn)
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PermitOffiter's Printed Name
Signature v
o tq-7 7 io -zol7
Issuing Dafe Expiratio Date

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: �(p S' C� �tZPrV✓uN�
Date: 05 A D�A�BITAT
1
Describe below the 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
temp impacts)
impact amount)
temp impacts)
amount
r
Dredge ❑
Fill ❑
Both ❑
Other
6
Lctaz-
Dredge ❑
Fill ❑
Both ❑
Other ❑
J
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑���
Dredge ❑
Fill ❑
Both ❑
Other ❑
proms �� e
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑
Fill 0
Both ❑
Other ❑

Date
Date
Check From
Name of
Vendor
Check
Check
Permit
Receipt #
Received
Deposited
(Name)
Permit Holder
Number
amount
Number/
Comments
Brunswick
Dredge and Dock Webster Carl
3/14/2017 LLC Basemore BB&T 7699 $200.00 GP 69016D BS rct. 3754D

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Cqulp)�Pw c. "� � e-
(Namq of Prope Owner)
property located at �� 5 ��J - .lam. a�T' �_D'T �
I/ ( Odress, Lot, Block, Read, ec.)
on TRAC1 l 14)1 in SkdSei N
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown belo the development proposed at the above location.
-�� I have no objection to this proposa
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
eig
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U' �J-
utu�e{ �
' 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.)
XI do wish to waive the 15' setback requirement. 40"4�
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
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Signature Sikiature
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Print or Type Name Print or T e Name
t2 &. � L�Ie. % '9 - G
Cling Address ailin�s
f{SILL Af-- Z8 $b� t?4
Cit /State ip Cit lstat /Z
2'' 33 7 - 711 Z-- 95 / — 7
Telephone Number Telephone Number
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Date Date
(Revised 6/1WO12)

ADJACENT RIPARIAI PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to W , 1 d' 0 ' e<yi�•s
1l,, —1 c Name. o Property caner)
property located at ` o ! c� 40 Y- -- I I � Q T .
(Address, Lot, Block, Road, c.)
on S-hAL- AI-?P , in SCkA/t.Sp-� Qaoe N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
urvd <f
c�-�=�►ILwG�y ..
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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
.e,,- C- 2: z e� r
NIr."cr m h• e Z)
Malh g Addres
Pic- 28-v'(w
Cify/ tat rip
,2 — 337— 7/IZ
Telephonembe
/0ni/Ul6
Date
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Print or T e Name
2a'%, S . "GA1 E�v0'
Mailing Address
t �-L�rntoe,Tt��►.t Nc.
J/-t6Z.s Gnu &, VA-
citylstatelZip
4 - -wrz, ZYss$
'70 3.5 1066
Telephone Number
Bate
(Revised 611812012)

Farrell, Sean C
From: Staples, Shane
Sent: Thursday, March 09, 2017 9:28 AM
To: Farrell, Sean C
Subject: 407 Shoreline Drive
Sean,
I am comfortable with using a GP to replace the floating pier of the same size in the same location. I would condition it
with stops 18" above the bottom.
Thanks
Shane
Shane F. Staples
Fisheries Resource Specialist
Division of Coastal Management
Department of Environmental Quality
252 948 3950 office
shane.staples Q ncdenr.gov
943 Washington Square Mall
Washington, NC 27817
-'`' Nothin(j Compares ._
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.