67258D - Fulwiler

+LAMA / ❑ DREDGE & FILL A B
31ENERAL PERMIT Previous Previous permit#
(New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources y
:oastal Resources Commission in an area of environmental concern pursuant to 15A NCAC C�
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t Name
S o L Co I VIA lots S
kVA 1% State` _ ZIP Z 3
OD3 9 b 5 "'A �5 E-Mail
ed Agent Mc (4-19\% h C
❑ CW IEW 1 PTA ❑ ES ❑ PTS
❑ OEA /❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
yes / no PNA yes / V
f Project/ Activity
oC
ck)length
atform(s)
es a c
Project Location: Countyry�,�J,Z
Street Address/ State Road/ Lot #(s)
Subdivision
City' ZIP 2 �N
Phone # (�` �) �" g 2 River Basin L VW
Adj. Wtr. Body 6-1A(A(nat 4
Closest Maj. Wtr. Body A�1 U\I IA/
not sure yes o--
•ium: n/a yes n C
yes T
4ttached: yes o { c t n r
ng permit maybe required by:
Local Planning jurisdiction) ; n
�cP CA o\
(Scale:
❑ See note on back regarding River Basin r

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant:
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.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
(Af
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
dis
Ex
Habitat Name
Choose One
anticipated
restoration
any anticipated
re:
restoration or
and/or temp
restoration or
ter
temp impacts)
impactamount)
ternimpacts
arr
Dredge ❑ Fill ❑ Both ❑ Other
1 V
1
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
Name of Property Owner Applying for Permit:
Larry/Diane Fulwiler
Mailing Address:
306 N Columbus Street
Alexandria, VA 22314
I certify that I have authorized (agent) William McRainey to 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) 30 Leland Street, Ocean Isle Beach, NC
This certification is valid thru (date) !m 3
a
s�; i.
8' �
Property Owner Signature Date

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERMWORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to Larry & Diane Fulwi ldr
(Name of Property Owner)
property located at LOT 46 Leland St.
(Lot, Block, Roa(
etc.)
on Canal in Ocean Isle Beach , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: Mailing Address: 306 N Columbus Street
Alexaadri.a, VA 22314
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
trust be set back a minimum distance of fifteen feet (IS') 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
I do wish to waive that setback requirement.
----------------- --------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMCNT
(To be filled in by individual proposing develop --it)
(Information for Property Owner Applying
for Permit)
3� 1
"c
(Riparian Proper , ^
306 N Columbus St
Mailing Address -

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/AIOORING PILINGSBOATL,IFTBOATHOUSE)
I hereby certify that I own property adjacent to Larry & Diane Fu lwi 1 dr
(Name of Property Owner)
property located at LOT 46 Leland S t .
(Lot, Block, Road, etc.)
on Canal in Ocean Isle Beach N.C.
(«aterbody) (Town and/or County)
Applicant's phone#:_ Mailing Address: 306 N Columbus Street
Alexandria, VA— 22314
Fie has described to me, as shown below, the development he is proposing at that location, and, t
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 (IS') from my area of riparian access unless
waived by me, (If you wish to waive the setback, you must initial the a propri
below.)
_RI do not wish to waive
I do wish to waive that setback requirement. �� laM ---------------------------- ----------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROP
(To be filled in by individual proposing !�
(Information for Property Owner Applying
for Permit)
306 N Columbus St
(Riparian Property Owner Information)
Mailing Address
S►gn tur

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