66541D - Brackett

7CAMA % [:]DREDGE & FILL ( Ll
`
ERAL PERMIT
7ew ❑Modification El Complete Reissue [-]Partial Reissue
A
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC " VV
,n El Rules attached.
t Name \NA (�� ( j "r (k Y \ ` 1,, tt �D( �• Project Location: County
Street Address/ State Road/ Lot #(s
` \ State ZI P_�f;,ro q j �' CX4 6 ( a
6% 7-7 `Aq E-Mail '�� Subdivision
ed Agent L�9 GQ \k City, ��� �� (� ZIP
❑ CW �K f W XPTA ❑ ES ❑ PTS one # ( i) �`i t b River Basin
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A % I
❑ PWS:
yes /(no PNA yes /
Project/ Activity i
:k) length j
itform(s)
Platform(s)
er(s)
igth -
nber
I/ Riprap len h
distance offshore
tlldozing
/,. —A 10"i in,
Length
not sure yes no
um: n/a yes no
Aye no
stached: \'.
B
Adj. vvtr. Body a V\. nat
Closest Maj. Wtr. Body
ig permit may be required' by:
_ocal Planning jurisdiction)
f ❑ See note on back regarding River Basin ru
_1 � t . i :✓ � 1 "i

NC Division of Coastal Mgt. Habitat Impact Con
Applicant: -41A t� �C� 501�1i e SaCI�
Date: It A- Q /
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
F
(Applied for.
(Anticipated final
(Applied for.
(i
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
d
Habitat Name
Choose One
includes any
Excludes any
total includes
E
anticipated
restoration
any anticipated
n
restoration or
and/or temp
restoration or
V
temp impacts)
impact amount)
tempimpacts
a
4
Dredge ❑ Fill El Both El Other �
5 � D
� � t�
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION.
Name of Property Owner Applying for Permit:
Mailing address: 3n) Ea e. s �aSS
�' 1 3�° v
Phone Number: (07 0 — 7 7 (c,- fa�-7 147
I certify that I have authorized -Bo� Ga)o---) fie.
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
l P 1 �" ?UrYY1 Q V—A `R o cL y i d oko C hko
at my property located at �� CSC 0" S �. boat 1(
in rvV-)SUJCck— County.
This certification is valid through zz� 2-0(7
Date
(Property Owner Information)
Signature
le, % • Scx,
Print or Type Name
Title
„CLI (_ — , .

16 ,
Apr 13 16 08:44a
img003.ipg
Ocean Isle Marina
910 579 8535 p.1
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Ar"j 't
s
property located at _ 1�
Ca, J (Name of Property Owner)
(�' I an (Address, ot, Block, oa , etc.
1.1 , in �
(Waterbody) N.C.
(City/Town a d/or County)
The
applicant has described to me, as shown below, the development proposed at the above locatio
v I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
e io e c4 o f'F
P k�, - J Far
��is �" � 1 �1�•s<t- lam=cl�
� r
tw o G an o 0 8N6 1
I r y
fio s t+ b't Gk , N 1' W k , C- 4- I.
i t•,r C �
WAIVER SECTION
I understand that a pier, dock. mooring pilings, breakwater, boathouse, lift, or groin must be set back
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.)
ZZL-) �'— I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
%MIA-
SignaturJu.,.... t
Pnn or Tr.GCn7S P SS
Mad r� I O l; 0
CityCrty/ :at��'1 7b 5�f�]1 b 5 M
(Adjacent
Information)
inn[ or N /
��f . /.:�1
3 19,
�s
M ng Address S` Z
city'ttat

Scan0001.)pg
kpr 13 16 08.44a Ocean Isle Marina
910 579 8535 p.1
ADJACENT RIPARIAN PROPERLY OWNER STATEMENT
I hereby certify that I own property adjacent to to *j ef-t
9 's
property located at 85 C wor d (Name of Property Owner)
I(Address,,Lot, Block, oad, etc.
on in AMM (Waterbody) N.C.
(Cityfi'own a d/or County)
The a licant has described to me, as shown below, the devetopment proposed at the above locatio
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)
y�0".� -e-
tt lr� P;lk�``�`�t ��. b0 A- I, t-
.tr 4-
N /U
WAIVER SECTION
I underst nd that a pier, dock, mooring pilings, breakwater, boathouse, It, or groin must be set back
minimu distance of 15' from my area of riparian access unless waived by me. (If you wish to wail
the # ck, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
' do not wish to waive the 15' setback requirement.
trroperry owner Information)
0�- G-ftkta-- ---
Signature ��
�(µt
Pn . nt or Ty e N mS
GJ
,'Vlarl� A pp'�re 1 �
City/Statelz4-4n ti -. r0-W ar,
(A"cent cent Pro rty Owner Information)
Si lure
03e'/Ci -
Pnnt or Type Name
Watling Address / �/
�_/1 �V �'�S c� Tom? / ><, /l/C �8 7 6`7
C:itV1.Rfa;a17in