67134D - Alleman

CAMA / ❑ DREDGE & FILL F/�i/l cp
'10NERAL PERMIT Previous permit# A B
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources /,
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 0-7 /"# • 1200
Rules a hed.
Name 1 124 �/U/% +/- //�1�/i/ Project Location: County 1'✓
Street Address/ State Road/ Lgt (s)
r _ 7,
3'4G!'s RD State��Z477 3Z— tH' '� /4 n �=
E_Mail Subdivision
:d Agent ,0 5-5 4 City A'. 92'5z tZ r�ZIP Z'4!t19
❑ CW ISZN/ KPTA ❑ ES ❑ PTS Phone # ( ) River Basin 6 X
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body `� %Yr�� %� s ari�✓n (rrar✓n
❑ PWS:
ies' /, no PNA <Ye�o
Closest Maj. Wtr. Body L So 41AII
Project/ Activity
k) length 7 (J
tform(s) 2-
'latform(s)
er(s)
igth
`ber
/*.prap length
distance offshore
c distance offshore
innel
is yards_
P
e/ Boatlift
Length / ,7- 16Q`
not sure yes
Am: n/a yes
yes
ttached: yes
v m
(Scale:
a
g permit may be required by: &.'o R �t'�5�� "� ❑ See note on back regarding River Basin
.ocal Planning Jurisdiction)

NC Division of Coastal .Mgt. Habitat Impact• Computer sheet
5 'mot/` .l I
Applicant: 1 '
Date: � � f �j � �X�
Describe below the HABITAT disturbances for the application.
All values should thatch the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
for.
FINAL Sq. Ft.
(Anticipated final
TOTAL Feet
(Applied for.
I'll
(Ar
DISTURB TYPE
(Applied
Disturbance.total
includes any
disturbance.
Excludes any
Disturbance
total includes
dis
Ex
Habitat Name
Choose One
anticipated
restoration
any anticipated
restoration or
re:
ter
restoration or
ternim acts
and/or temp
impact amount
teMP irri acts
arr
(�
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other [I
r

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
T/m It Cyr �(
Mailing Address:
GdU) s &.)12-e) , AJ& >%�3 �
I certify that I have authorized (agent) AkC41,12to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) 6,, �/Z /y ���� / V Aa6
This certification is valid thru (date) `v( /;;?
'7/zb/If b
Property Owner Signature
Date

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: T ,�ri� c�h'� yL 1 j� �►/
Address of Property: �yL 0,VJ/--)iJ
(Lot or Street #, Street or Road, City & County)
Agent's Name #:C&t& Mailing Address:
Agent's phone #: 7(; 7 - Sit op J- &W .NL
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 areproposing. A description or drawing, with dimensions, must be provided with this letter.
� LV��havdkVobjections
to this proposal. I have objections to this proposal.
Aou 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. Contact information for DCM offices is
available ata? Eo://�ivvJ,U.,7cchestta nianr7cen7e,,-, .:��Y/r ? ,r `�
:�ic��/�,�F:-tt�siiz�. or by calling9-888-4RCOAST.
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, boat ramp, 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' setback requirement.
1 do not wish to waive the 15' setback requirement.
(Prope er Information)
Signal-6
Print or Type Name
/00'90X I a'�,;7
hfQX,i& ,a.U—;--
ice. , /1 , A . - A.A ,? -S,-a
(Riparian Property Owner,formation)
Sign re
y x dc, -e
Print or Type Nanfe
Po sox 904
MaHtr ry 7071 Coo A
.L/ htIl,' J/ AY/" 'J 7

Pilings and More
910-327-6353 0.1
RT FIED MAIL - RETURN RECEIPT RE T 0
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFiCATIf N/WANER FORM
Name of Property Owner: ,r✓iJ L
Address of Property: h �dyj�v
(Lot or Street #. Street or Road, City & County)
Agents Name # C ir MailtngAddress: /��
Agents phone J
I hereby oertify that I own property adjacent to the above nefWanced property. The individual
applying for this permit has descrlbed to me as shown on the attached drawing_the development
tf,�ey are proposing. A descHiption 2Ldrawinq,wish-dimensions t be provided Wfth this t r.
I have no objections to this proposal_ I have objections to this proposal.
Nyou have objections to whatls being proposed, you mustnotffy the DA4slon of Ccastaf A4anagernent
(OCpi hr WNW within 10 days of receipt of hits no&ca_ ConW1 inFd m&hon for DCM m%cas [s
avai►aDleet o:// ✓::.�-c,; a 's:r�r�necs o.-'iee 1r �;:,'��� `-" �; orbyconing 1-888.4RCOAST.
rUo once 1s considered tare sauna as no 2Lmegon ifyou have bean noriFred hV GwIflled Mait.
WAIVll SECTION
urdersinnd that a pier, dodo, mooring pilings, boat ramp, breakwater, boathouse, or lift must
be set back a minimum distance of 15' from my area of ripalan access unless waived by me. (lf
you wish to waive the -,eta(*, you must initial the appropriate black below.)
i do wish to waive the 15! setback requirement.
j I do not wish to waive the 15 setback requirement.
(Prolporl er InforrnatSon) (Riparian Property Owner Information)
Signa e Si re
a cs N
Print or Type Name Pnnt of Type Name
nn�xt � �9.�rdew `�-
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