67131D - Foster

I CAMA / ❑ DREDGE & FILL
"ENERAL PERMIT Previous permit # A B
]New ❑Modification [-]Complete Reissue El Partial Reissue 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
❑ Mules attached.
t Na-m-�e „ U S F Project Location: County c, . t,
/ Cf ✓ U L� C�r �" ` UG Street Address/ State Road/ Lot #(s)
State ZIP %(�� `�' - (.� ''� /J S
Jill J III I Jill IIJ
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offshore
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Lx distance offshore
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on
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ulldozing
e Length
not sure yes no
ium: n/a yes no n
yes no
4ttached: %7
ng permit may be required by: ❑ See note on back regarding River Basin n
Local Planning Jurisdiction)

NC Division of Coastal .Mgt. Habitat lrn jaaot• Ctinp>Iutgr sheet
�OG V1
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.
for.
FINAL Sq. Ft.
(Anticipated final
TOTAL Feet
(Applied for.
(An
DISTURB TYPE
lied
(Applied
Disturbance.total
includes any
disturbance.
Excludes any
Disturbance
total includes.
dill
Ex(
Habitat (dame
Choose One
anticipated
restoration
any anticipated
restoration or
res
tern
restoration or
tem im acts
and/or temp
imp -Act amount
tem irri acts
am
F—Ai�7—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 0

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit:
Mailing address:
Phone Number:
410 - 32-ri -7Db
I certify that I have authorized F�tl I�-►17 k@1 V
Agent / Contractor
to act on my behalf, for the purpose of applying rrj and obtainingall CAMA permits
necessary for the proposed development of k1� bui k ��i A
IZ k�b �42-F—Ld
at my property located at 4-� ,
in D tJ -<JnL j County. '
This certification is valid through [�ee ZC I(,
Date
(Property Owner Information)
A
Signature
Print or Type Name
rtia

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner:
Address of Property'
(Lot or Street #, Street or Road, City & County)
Agent's Name #: G��21 I+-11tII,12 Mailing Address: 27(4 PALA l� Y
Agent's phone #:
Agent's email: 4� r.Dh�L- Ue�ioN Qh210 �.Cc�
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are roposing. A description or drawing, with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this ro osal.
p p
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
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
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
wi; wave the setback, you must initial the appropriate blank below.)
I do wish to waive the 15 setback requirement. Ui���c»k9 ati �oe
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signatatr
Print or Type Name
Mailing Address n I
(Adjacent Prope,r* Owner Information)
Signature /
L,JL LY-L',niv
Print or Type Name
205 P,,, ea 2
Mailing Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: �aa� fDL° YC
Address of Property: (1, 0 30
I , (L
ot or
Street #, Street or Road, City & County) f'
Agent's Name #?�tlL.� �1 Mailing Address: Z.1� I'►tQ
q �1� J� '"
Agent's phone #: )1Q- 3?�- SSbC) �RC_lCSZ�NVt �� i N, C. Z.DSyt)
Agent's email: V. k. CAN St1211�i Dnl (� �,v-� rrai I . C 1
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
they are proposing. A description or drawing, with dimensions must be provided with this letter.
r ID
I have no objections to this proposal. 1 have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
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
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
wis ive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement. Dati
I do not wish to waive the 15' setback requirement. 1
(Property Owner Information)
BdZkv'�
Signature
Print or Type Name 1
7-Sf3 rA ►2 inn �+ I ti �.
Mailing Address
(Adjacept Property Owner 1 formation)
Signature
0—k 140 iU I e
Print or Type Name
9-6 .3l .
Mailing Address

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