73521D - Keith

1CAMA-. / DREDGE & FILL NO. 73521 A B C Q
• GJENERAL PERMIT Previous permit#
flew ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality y
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC U / H j ` Vyt + �-
"� '/ ❑ Rules attached.
Applicant Name Vou-6,LAs KE ii-ra Project Location: County -9iR ,&ALS w %CK
Address 30 0 4 TC*Autiv 14A w ]r aL Street Address/ State Road/ Lot #(s) 13 2..
City .ApCI't StateNc, ZIPZ7531 LSAI.FWH —Dy4yr,
Phone # ( 111 0l-c1100 E-Mail dkeAh 001 ®gC,rr.carnSubdivision ,p 1&
Authorized Agent %3RIA 1 MµwoCAC City kAO%-pew/ E-;F_J►CH zip
Affected ❑ Cw )6w )<PTA gES XPTS A4r_K-r Phone # (&I %44UP4-012 o River Basin
❑ OEA ElHHF ElIH ❑ UBA El N/A AEC(s): Adj. Wtr. Body G/lAJ♦t, (na<Jma /unkn)
❑ PWS: —�-
ORW: yes / PNA yes / °© Closest Maj. Wtr. Body A
Type of Project/ Activity ;ZEIAOVC f_XmVri#J*k BoAT IZA► IP I COwJTV"c-r NCvi $Lx4.0J4CJy
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A building permit maybe required by: 4p 1►DYCw/ SEAC.FI ❑ See note on back regarding River Basin rules.
( Note Local Planning jurisdiction)
Notes/ Special Conditions O 1 N • 10 0 $ # ;ZOO A.I D All p ;HER WCA L S Sm'"r—
�r 1Ci0 ERA-L. A 9-4 LA L_ A— luNs /I DPW.O
3tiAkyj I A I (A
Agent or ApplieRnt Printed Name
Signature Please read compliance statement on back of permit *v
z600 k 1vs2s
Application Fee(s) Check #
Permit Officer's Print Name
Signature
SAY AZol9 q /8/zollq
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Vb cut laS K-eA-4-h
Mailing Address: �3t 6 ( 20 � 4aA, ! II-- Ql,
Phone Number: a (-I t — a
Email Address: nod- 6g n c—
I certify that I have authorized VCCInc -•
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Fi�c cck� r�mcsv��
"A ra ,yam p
at my property located at
in 2,ru -,u 3i c-k— County.
I 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:
i
gn re
tint or Type Nat -no
Title
3 In, �t 20t
Date
This certification is valid through

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: 176 u at ,a S
Address of Property: 13a Sail-Fi'Si1 �' {-katdten gz �'ur ►��'ri'�,
(Lot or Street #, Street or Road, City &County)
Agent's Name#: y-Ce- Mailing Address: On R'6) %-W
Agent's phone #: q to lo-ULl o rho 5��o! ►*<<- �$`�� �-
I hereby certify that 1 own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
Ifyou hale objecfloas to whatis being proposed, you must notify the Division of coastal Management(DCM) In
writing ►vlthin 10 days of receipt of this notice. Correspondence should be matted to 127 Cardinal Drtva Fact.,
Wilmington, NC, 28405.3845. ACM representatives can also be contacted at [phone]. No response Is
considered the same as no objection if you have been notified by certified Mall.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian access unless waived by me. (if you
wish to waive the setback, you must initial the appropriate blank below.)
`-'� I do wish to waive the 15' setback requirement. i'�- tsnt -1 -b -14y/ �+- rc ma re old r--a"'p
I do not wish to waive the 15' setback requirement.
(Property owner Information) (Adjacent Property Owner Information)
Sigtia.10e Signature
Print or Type Name
Melling Address
Cityl .tafelzip
(q,60 CHOI- ggq8
Telephond Number
Date
Print or Type Name
134 5ai
Mailing Address
PAan gearm NG ot$�o2
Cky/State2lp
of la--41-7-
a Telephone Number
�It It�t
Date
Revised 6l M012

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ,Do uq(as
Address of Property: Sc (-Rsk Q- I-bldep G na-r-k
(Lot or Street #, Street or Road, City & County)
Agent's Name #: V C G, TrnC • Mailing Address: 3m3 Eck P J. c�W
Agent's phone #: 11- 1D (' .4 b17ge '5>�*pt�-.�1,,Jc2gu c,2
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 propo 'ng. A description or drawing, with dimensions, must be provided with this letter.
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 you have been notified by Certified Mail.
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 waiv the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. * cnky 4-o fi rerv.ove- aid ,ramp
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
&g7on 15 ■�
Mailing Address
N C�,
City/Statelip
(a(a) q(P(-
��gg
Telephone Number
�T1 101
Date
(Ad ace rope Owner formation)
Signature
LGn i�Grr ► `c� IL
Print or Type Name
13fl � � (-Fi-s h Sfi•
Mailing Address
pr,ld-cnc,1-�
City/State)Zip
33-6
Telephone Number
Dale
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Revised 6/1&2012

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