66660D - Fulcher (2)

CAMA / 7 DREDGE & FILL l E
/ A
PENERAL PERMIT Previous permit #
Mew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources --.)
oastal Resources Commission in ary4 ea nvir p egtajs�oncrerntpursuantSo I SA NCAC
C �- C r-6 - ❑ Rules attache
Name r. Project Location: County l(1
? ' Street Address/ State Road/ Lot #(s)'
State ZIP_
Subdivision 11 A M
;d Agent I 1 City V' ZIP , t`
❑ CW El ❑PTA / El Phone # A River Basin ILIA VU
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body' —PA Ve /
ElPWS: nat n
Closest Maj. Wtr. Body
ies r/ no,) PNA yes Cno
tt
Project/ Activity
k) length_
tform(s) _
Ilatform(s)
igth
nber _
I/ Riprap lengthr
distance offshore-
( distance offshore
annel
is yards_
Ip
;e/ Boatlift
Length '' t— I I V
not sure yes gno
um: n/a yesyesattached: yes
ig permit may be required by: _
-ocal Planning jurisdiction)
(Scale:
B
f� �� / .c� li\ i� ❑ See mote on back regarding River Basin rL
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:, r, v -
Date: L. t3 (- �t ,f
Permit #:
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/or
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 0 Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Fulcher Real Estate LLC
Mailing Address: PO Box 53650
Fayetteville, NC 28305
Phone Number: 910-323-5589
Email Address: [e-mail]
I certify that I have authorized Michael Lay
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at 2018 W. Sea Aire Canal
in Brunswick County.
1 furthermore certify that 1 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 ¢goner Information:
Signature
Garret Lee Fulcher
Print or Type Name
President
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _, �/t,� . t4a ,s
(Name of Property Owner)
property located at
�� (Address, L ,Bock oad etc.)
on��
irL, �ell_N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatior
V 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 bac
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wa
the setback, you must initial the appropriate blank below.)
/ 1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
SIgl7eillll'G'
Print or Type Nance
(Adjac Property Owner lnformatio
IgI1 re
Print or Type Name
,ob z -z -- id . Ser-. Gam/

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to r1, jkl? e_0 's
o o , • (Name of Property Owner)
property located at
(Address, L t, Block, Road, etc.)
on �M A,9 c,�( Lic'-G to in , N.C.
(Waterbody) I (CWylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatic
pe-�� 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 ba,
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w
the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
not wish to waive the 15' setback requirement.
(Property Owner Information)
cent P
rmation)
Signature S' mature
lWe- p-,
P int or Type Name Print or Type ame