67151D - Avalon

LAMA / ❑ DREDGE & FILL
xtNERAL PERMIT Previous permit# q B
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources j loop
coastal Resources Commission in an area of environmenI concern pursuant to 15A NCAC /% ♦
C% `';JLt /e Remles aached.
��Name lot, I�f�4, !. Project Location: County /I �P,w
ZIP ZYO
O -Mail
:d Agent
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�.J;r tNu9 T Pre S
p CW
IVEW//l ❑ ES ❑ PTS
❑ OEA
❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
/n/ no
PNA O no
Project/ Activity ejclsti�
:k) length
tform(s)
�latform(s) fi j
igth
nber
I/ Riprap length
distance offshc
K distance offish
annel l
,ic yards
1p
Street Address/ State Road/ Lot #
Subdivision 11-00 /d`i L.1Gt /C S
City W 1! i b" ZIP 20 %
Phone # (" f! sW9 River Basin
Adj. Wtr. Body f ww at Ir
Closest Maj. Wtr. Body.✓�'�
/iJ (Scale:
❑ See note on back regarding River Basin

NC Division of Coastal. Mgt. Habitat ImPaot Computer Sheet
Applicant: IT- /Cn �-, l� Permit #:
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
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft,
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes -any
restoration
and/or temp
impact amount)
TOTAL Feet FINAL Feet
(Applied for.. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
L✓
Dredge ❑ Fill ❑ Both ❑ Other rKZ
Dredge ❑ Fill ❑ Both ❑ Other El
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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑: Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge,❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both �3 Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit.-
��� r�
Mailing address: k!v U V H A S W;,
L �C
Phone Number: cl to, — L{ (p — 0
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of(�Q
"-jA-I L-\ -F�ff
at my property located at
in �� County.
This certification is valid through it
Date
(Property Owner Information)
Signature
4t�tL �-eA N
Print or Type Name
nojvd— )
"'D

N PROPERTY OWNER STATEMENT -AlOW
I hereby certify that I own property adjacent to
property located at
t
(Name of Property Owner)
/M4's
on Ce���� ,,99 (Address, Lot, B o k, R ad, etc.) �
+i �A , in ( (US- Wit NfN.C.
(Waterbody) (City/To and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatic
_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRA
(Individual proposing development mus
*4 -IZ6���
N
ZING OF PROPOSED DEVELOPMENT
fill in description below or atta a "te
r
ri'�'2
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish t w�
the set ac you must initial the appropriate blank below.)
set
wish to waive the 15' setback requirement. v
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature o� 6L'xc ., 6A1 ' Si
Print or Type Name Print
Property Own
re
Type
T Na e

ADJACENT RIPARIAN PROPERTY OWNER (STATEMENT
hereby certify that I own property adjacent to 4 l �- 1 J�i(/l 's
(Name of Property O ner)
property located at ZO" %`J 0_
(Addre s, Lot, Block, Ro d, etc.
on (/U in W t C-- - N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatic
I have no objection to this proposal.
I have objections to this proposal.
JUL 2 6 2016
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
�.� J � Ct'J�.J a S f�V i S� C2r C! qQ � � r ��i
7�- u S r CO J J-o `n^t P nr�i d SAC P.L(a� ,1 'jZ^c rt' as
U J s �-.,t � AS $1
rt.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or Oroin must be set bac
minimum distance of 15' from my area of riparian access unless waived by e. (If you wish to w
the setback, you must initial the appropriate blank below.)
I do wish to waive the 16' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Inf ation)
Si ature
Print or Type Name n
2/-,1 1A i l,i�i
(Adjacent Property
Information)
Signature
RECEIVED
Print or Type Name - IUAINGTC

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