67160D - Bear

ICAMA / ❑ DREDGE & FILL
i
1EN ERAL PERMIT
A B
Previous permit #
;klew ❑Modification ❑Complete Reissue El Partial Reissue
Date previous permit issued
•ized by the State of North Carolina, Department of Environment and
:oastal Resources
Natural Resources r t
O7
Commission in an area of environmental concern pursuant
to I SA NCAC W
t Name
❑ Rules attached.
Project Location: County ii�(ln/lrsl/lr1Z.
Street Address/ State Road/ Lot #(s)
StateN C ZIPYl���
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C 9 O E-Mail
Subdivviisiion
ed Agent v1
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City t X(ZG1� �rS1t_ ZIP a(a e
❑ CW ❑ ES ❑ PTS
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_OTA
❑ OEA ❑ HHF j❑ 1H ❑ UBA ❑ N/A
Adj. Wtr. Body air'1 nat
❑ PWS:
yes / n PNA yes /
Closest Maj. Wtr. Body �y V
Project/ Activity
_ocal Planning jurisdiction)
70 l
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WC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:r Permit #.Date:k0or
D 11 1aoI (�
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
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/oi
temp impact
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 ❑
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 ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date August 11, 2016
Name of Property Owner Applying for Permit:
Barton Bear
Mailing Address:
12008 Howie Ro
Raleigh, NC 27613
I certify that I have authorized (agent) Palmetto Marine Construction. Inc. to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 10.000 lb capacity boat lift ,
at (my property located at) 29 Fairmont Street, OIB, NC
This certification is valid thru (date) December 31, 2016
Property Owner Signature
Date

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(TOR A PIER/MOORING PILINGSIBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 5L601 `s
r' eC11 (Name of Property Owner)^
property located at A FwMo(1} !�
(Lot, Block, Road, etc.) Q
on 8. Gbt19� , in ODU Wt, 1.�t1th , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #yo" Mailing Address: wousz ` kj 1 c iA
A& s e-3
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I Y) 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 not wish to waive
qL0
1-M I do wish to waive that setback requirement.
---------- ------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposinh development)
--------------------------------------------------------
(Information for Property Owner Applying
for Permit)
iace1z �bwie �
Mailing Address
(Riparian Property Owner Information)
�cpww4oqw-,
Signature
1Q 6 0L, c- t._. _ /U/ a-/o
"Cwaak PtAf a

US MAIL
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
dame of Property Owner:
Address of Property: oZ �I r� it ✓ �1d� cS7��
(Lot or Street ##, Street or Road, City & County)
Applicant's phone 491 q -5W— X,3i?,
Mailing Address: lade 1-bwtp— ke'
i hereby certify that I own property adjacent to the above referenced property. The individual applying for this perm
ias described to me as shown on the attached drawing the development they are proposing. A description of drawinj
with dimensions, must be provided with this letter.
J/ I 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 (DCW,
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ex
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
[ understand that a pier, dock, mooring pilings, breakwater, boathouse or lift must be set back a minimum distance o
I S' from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
appropriate lank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the IS' set back requirement.
(Property caner Information)
Si tore
L Q�
Print or Type 11ame
C�� *1tJ119 �C
Mailing Address
Pn ( n 'r^ / A ,Z _771-.
(Riparian Property Owner Information)
Signature t-1&V!It1 C4NtVD l i
y
Print or Type Name
7k.5
Mailing Address
4 1 - i - -t-1- - ,. r x- � a 4 -a"

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