66310D - Froschheiser

J CAMA / ❑ DREDGE & FILL IC V/�I/ I"ENFERAL PEARAIT �p
ew ❑Modification ❑Complete Reissue ❑Partial Reissue
riz by the State of North Carolina,, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
_.i
A B
Previous permit #
Date previous permit issued t
. 1? O©
❑ Rules attached.
it Name
Project Location: County )
Street Address/ State Road/ Lot #(s) ✓,�"
1 A!401y!%J C
ti- State ZIP U
%'( f �- /JR.fii S�LC��'t ' 114
E-Mail
Subdivision t:vi S /�C-
:ed Agent
City , -AI.4 ZIP ,
❑ CW
SEW
e.PTA ❑ ES ❑ PTS
Phone # ( `j'— "" River Basin/J� ,
❑ OEA
�❑ HHF
❑ IH ❑ URA ❑ N/A
�J '-/-,
❑ PWS:
yes / no PNA yes /11�
f Project/ Activity
Eck) length
atform(s)
Platform(sl
iier(s) x /�
Ngth
m'ber
d/ Riprap length
g distance offshore
ix distance offshore
hannel
bic yards
np
ise/B"tlift
e Length N IA—
not sure yes
•ium: n/a yes
yes
4ttached: (19 no
��
ng permit may be required by:
Local Planning jurisdiction)
Adj. Wtr. Body,-- d I r Cf!7 nat
Closest Maj. Wtr. Body
(Scale: 1
❑ See note on back regarding River Basin r

NC Division of Coastal .Mgt. Habitat Imp. act Computer sheet
rs
Applicant:
Date: LJl.— 2-7? I (�
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
FIB
(Applied for.
(Anticipated final
(Applied for.
(An
disc
DISTURB TYPE
Disturbance.total
includes any
disturbance.
Excludes any
Disturbance
total includes
Ex(
Habitat Name
Choose One
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
temp im acts
impact amount
ternirri acts
am
UV
Dredge ❑ Fill ❑ Both ❑ Other
�o
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:
Mailing Address:
�c��s���11� �G 2Fs5y0
I certify that I have authorized (agent) 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)
This certification is valid thru (date) (Zb
Property Owner Siunature
T%-

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOT
�IF
'ICATION/WAIVER FORM
Name of Property Owner: �' � f-rDsckb-e �-tn---
Address of Property: r 0-- 1 r 10,V�-YVAJ l
(Lot or Street #, Street or Road, City
Applicant phone #:��n��
l�('�
Mailing Address: v��o� Cvr Aj-'+
21( o
I hereby certify that I own property adjacent to the above referenced property. Tht, 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.
JI 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 Coasta! Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. 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, or lift must be set back a
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
waive the setback, you must initial the appropriate blank below.)
111fL) I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
1 "'I( f rc'SCLA�e,Se+—
Print or Type Name
4�iq) 15bLi14Zky- I'I)
Mailing Address
(Riparian Prop rty O ner Inform tion� )
Signature
Mf,(- * C' e- i k- 0 S-
Print or Type Name
G I H c.' u r I v c,.,�� ✓�,
Mai#gg Address I

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNNE�`nRNOTIFICATION/WAIVER FORM
�Name of Property Owner: 1 t �SC�t' I 6CA S��
Address of Property.
(Lot or Street #, Street or Road, City & County)
Applicant phone #: Nh
Zb2hRAJ,t6Wailing Address:
217 S� rc�o
I hereby certify that 1 own property adjacent to the above referenced property. Thd 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.
,11
�,,O 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 Coasta! Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at www.nccoastaimangement.net/contact_dcm.htm or by calling 1-888-4RCOAST. 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, or lift must be set back a
minimum distance of 15' 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Print or Type Name
Sk `t, F b ji 'i S P'o
(Riparian Property Owner Information)
Signature
4015 L- i) r I
Print or Type Name
2� W rlctAk�&.,, AFL
Mailing Address Mailing Address

{
F
-
�.5L l�Z.
L� Ali—
i
/ t
JEW
C�ovCu �NTo
►0 3� S L1
f
� D1✓QtND�U` �N
VOLIE W►D 1
jrlcf
A\\ %LS , A
0l.1 j lk\S S%V
Uo t�L�
N 0 Li 6 F
Zti -Cll1S 7s1