66681D - Fisher

JCAMA / O"DREDGE & FILL
*, P-RAL PERMIT
New ❑Modification ❑Complete Reissue El Partial Reissue
6" -- A B
Previous permit #
Date previous permit issued
•ized 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
R`R
) ,t ules attached.
Name l eG ///z� A �S oil Project Location: County A ,,I tiz
A J . tiy t- Street Address/ State Road/ Lot #(s)
Lf i t I State �! C. ZIP
�t) � E-Mafe ik . pis tvr I(tin Subdivision -----
�--
ed Agent .. E 707 City. //(/%'1��f %51�/ � T!! ' lzIP
❑ CWI ❑ EVN El PTA 1rQE5 ❑ PTS Phone # ( ) f� : �Z River Basin
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ N/A Adj. Wtr. Body fnat
❑ PWS: j f�
yes / no � PNA yes /0
Closest Ma. Wrr. Rnrfy %�Ll%/�' 6,rs
Project/ Activity
Riprap length --/
distance offshore
K distance offshore_
:Length ^"S
not sure yes no
um: n/a yes no
�.:�'
ttached: yes f no/
ig permit may be required by:
.oval Planning jurisdiction) -
See note on back regarding River Basin rt�

MC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant; �/ C"�'1/��JSG-i �� PefPlllt #.
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 .
FINAL Feet
(Applied..for.
(Anticipated final
(Applied for..
(Anticipated final
Habitat Name
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludesany
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts.}
amount)
Dredge ❑
Fill
oth ❑
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 ❑

■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
oe
a 7 --7 L,�,�
A. Signature
X (f�l I-� 1 ' �(Y�!%�
❑ Agent
❑ Addre
B. lived by (Printed am
C. Date of Def
D. Is delivery address different from item 1?
If YES, enter delivery address below:
LJ Y2$
❑ No
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III
3. uNICe Type
❑ priority Mail Express
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❑Adult Signature
It Signature Restricted Delivery
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Delivery
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2. Articlo ��• •T�-- T
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Ilect on Delivery Delivery Restricted D❑ Signature Confirmation-
? 014 2120
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] Signature Confirmation
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Restricted Delivery
—
(over$500)
PS Form 38 11, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
U.S.
Postal
Service"
CERTIFIED
MAIL° RECEIPT
Domestic
Mail
Only
For
delivery information,
visit our website
at wwwusps.coni
� 79 ' s x
ru P9a 0480
_ 14
rM
0
certified Fee
_2 8 a�
0 �'9
Q
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Return Receipt Fee
(Endorsement Required)
�•00 Herg���
O
Restricted Delivery Fee
(Endorsement Required)
J N 1 2016
ru
$0.4-1
ruru
Total Postage & Fees
$
$6.
Sent To / u LISPS
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ori
M1
------ ---
or PO Box No.
or PO & Ap[ Ko.. a 3�
--------- ------------------------
'h+�n l n ' Illy
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/� /---------------^./-------�-----------------------
City State, Z/P+4 M j L1, j6pil v

Pat McCrory
Governor
A
MA
NCDENR
North Carolina Department of Environment and Natural Resources
N.C. Division of Coastal Management
AGENT AUTHORIZATION FORM
Date: ! �1;1�
lame of Property Owner Applying for Permit:
V f C 4i?YaC ��dk"
Wner's Mailing Address.
'SOL11T�M,
mail k'i,A-• fisllL^,
hone
John E. Skvarla, III
Secretary
Name of Authorized Agent for this project:
1'r1rr�;
Agent's Mailing Address:
Phone
certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
x, and obtaining all CAMA Permits necessary to install or construct the following (activity):
or my property located at p ,74
his certification is valid 1 year from (date)

DIVISION OF COASTAL M/1MAGEMNT
ADJI4CLgNT MARIAN PROMtT1f OMlMM NCT MATH WAIM FORM
Main of Owner kleimw r3�.
Aft= of F"pWV.. � 1 � � )VI IoWdb*IJ?#'" �A JPiJ '31k'
p.d or arm R stye` * Raw, GAr i Cog*)
Ap Ws Nome* G c/ t'I+1n,6 - Moog fAd*m:
A9efft Owe S: D' MN 1. 2ft yPA)
I hMft 000 OW I own property s $md to the above rs+llerenoed property. Ths
apptyinp tar ttcie permk hes d..oitt,ed a me se,ehawn on � drswir�rte development
they err. ww+o�w-
I Irge W objections a tlds PWNW. 1, a -- >n fhb IXWO d.
r � �s.a.��e.�r�n�r�+�r++nrr�►w.ow�a��..rw�r�w
«rail. dip ant+e�t aarr wsr� o.shmm w spa to tv air~ o"eR.
i mWf4m my ow Ae bo oederolr.s (No 7011-ara M. mow» is
WAWER BECTWN NIff
I wWoswW that s pier, dock. mmft pihpe, breakwater. bOWWt ee, tttt, or OmI t murt be W
bade a minirntan datanoe of 1S *om my aM of dPO ien eocees urdM waived by me. (It you
WW to wdvr the selbadc, you mad kM to Lapp mprtebe bW& bdow.)
I do wish b waive the 151 utmuk ro*dmnent.
I do not wish to waive the if setback requkwnwd.
prnlcrtllatiolt)
At loft
PMnt or IWo hers
I 1
Signalm

MARKED .
\t Syfr
I OF4LLE N.P.S. �ay�cl
ANUARY 4°
N� 2
mCIRCLE p
N.H. W. L.
L HIGH NEW BULKHEAD VICINITY MAP NO SCA,
LINE AT APPROVED
-- _ _ Q5 CAMA ALIGNMENT NOTE
LP.S. 1.) THIS LOT /S LOCATED IN �
:E SHEET 33.58 P.O.L. AREA OF 100 YEAR FLOC
OF 2 FOR I.P.S. a 2.) OWNERSHIP OF FEN(
tA
41T8gX&g P.O.L d ALONG t? IS UNKNOV
AT APPROVED o �0�TO SURVEY(
CAMA ALIGNMENT -71
4' PICKET m P�OJ EXISTING WOOD BULKHEAD FENCE `r SEE SHE
*VOD WALK o 2 OF 2 Fl
4' PICKET FENCE-- I p BOA T DOC)
STARS
9 8, 120 HVAC LOT 3-6
DECK
CONCRETE J.P. s
POWER /
I POLE
ADJOINER'S 15.0' I '51OP�� �o�• a /
PORCH LINE �R 0 WOOD W
0
nit; ` • .. DECK 0
d ry
v o / BLOCK
o / WALL
LOT 3-4
WOOD `+ �• POWER /
• :`:.• .. DECK N STAIRS " I . POLE
wo CONCRETE BLOCK A
WALL
DRI VEWA YDO
/GE
LOT 3-5 Al .: NREP
20, 835f /� .�
\ S�Sq.Ft. /e� �IK �J AlREVIS/OI
E.I.P. SFTB� �/�h � P ' 0512711
ADD NEV
BULKHE�
POWER \ A T CAMf
. T 1 OF 2.
�j' moo° •� E.I.P. POLE J�V ALIGNME)
SURVEY (BENT) ' Q SHEET 1 OF
LOT SURW