67924D - Buccaneer

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: I) 0 CC C--V t� S. To
Date: t % l b/Z 0 t (,,, .
Permit #: 4Z � 2 Lf--ir�
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) impacts)
FINAL Sq. Ft. TOTAL Feet . FINAL Feet
(Anticipated final (Applied for.. (Anticipated final
disturbance. Disturbance . disturbance•
Excludes any total includes Excludes any
restoration any anticipated restoration and/or
andior temp restoration or temp impact
impact amount temp impacts) amount)
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 171
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 0 Both .❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 10- A) G��
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
.,c 33 Co-&aq--ez7
UV�05-,4,5 4i 4r�4 ; JU'�<-1
Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
K i)LAC¢
at my property located at E4y
in t0 7A.4V/C/L- County.
-�W.
rp LS/7.4yI?
�CO
1 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:
Signature
R o out. LQ 1'. Y)A 061`S
Print or Type Name
PRa�iOl�iU 3 c�c� �fN> LLB C),14 T,v C
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Buccaneer Hills Property Owners Association Inc.
(Name of Property Owner)
property located at J-- qy Roger Drive Parcel # 24600001
(Address, Lot, Block, Road, etc.)
on Intracoastal Waten�- M- _ , in Supply NC 28462 Brunswick County N.C.
(Waterbody) (City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above location.
xx
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)
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 belov(.}
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Print or Type Name
RN IQL A /S /'h 65CI
Madin—P-0 orx s� 1 t
(Adjacent Property Owner Information)
Signature i
Print or Type Name William I. Shankle President
Buccaneer Hills Land Owners Association lnc.
Mailing Address
PO Box 344 Supply NC 28462
City/State/Z�Q „ , , > I i-
Citu/State/Zio

tuccaneer Hills Property Owners Assoc. Inc.
,onald F. Moses, President
Borth End of Jolly Roger Drive, Supply, N.C.
Vidth 27.33 feet Land
feet X 65 feet Loading ramp (pier)
Vater depth at low tide at end of pier 0 to 4 feet
>istance to Channel: See attached
.equesting permit to repair/replace 4 foot X 65 foot damaged during
lurricane Matthew.
0 i'
T,4 5eci,a#-J of
L-� Q ov, r 0,
Poo
if.' oc . Tr 1J/ G
b�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _ Buccaneer Hills Property Owners Assoc. Inc
(Name of Property Owner)
property located at _,
on S C W
(Waterbody)
Road,
own and/or County)
C- 0
N.C.
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)
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 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)
Si Cure` a,4
, olme4---
Ronald F. Moses, President BHPOA Inc
Madress
/ 0 U A li L{
(Adjacent Property Owner InformatioK
mil- . f ,,, lir (\ //
or

Buccaneer Hills Property Owners Assoc. Inc.
:onald F. Moses, President
forth End of Jolly Roger Drive, Supply, N.C.
Vidth 27.33 feet Land
feet X 65 feet Loading ramp (pier)
Vater depth at low tide at end of pier 0 to 4 feet
>istance to Channel: See attached
requesting permit to repair/replace 4 foot X 65 foot damaged during
lurricane Matthew.
31
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14 Li,S ►°a a D 1✓�_ ► �( D1,�u�zs
a27-sa

uccaneer Hills Property Owners Assoc. Inc.
onald F. Moses, President
.orth End of Jolly Roger Drive, Supply, N.C.
Tidth 27.33 feet Land
feet X 65 feet Loading ramp (pier)
later depth at low tide at end of pier 0 to 4 feet
Distance to Channel: See attached
equesting permit to repair/replace 4 foot X 65 foot damaged during
:urricane Matthew.
I
e TW5 S cTjao o�
�s � 2►11` � � n R�rrO
3'
In
66,

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North Carolina
r S
Maine F. Marshall
DEPARTMENT OF THE
Secretary
SECRETARY O1= STATE
PO Box 29622 Raleigh, NC 27626-0622 [phone]
lick Here To:
I
hew Document Filings
:orporate Names
Legal: Buccaneer Hills Property Owners Association
Von -Profit Corporation Information
Sosid: 0224224
Status` Current -Active
Annual Report Status: Not Applicable
Citizenship: Domestic
Date Formed: 3/3/1988
State of Incorporation: NC
Registered Agent: Moses, Ronald F.
I
orporate Addresses
Reg Office: 2416 Jolly Roger Drive SW
Supply, NC 28462
Reg Mailing: PO Box 344
Supply, NC 28462