66302D - Grennan

�CAMA / ❑ DREDGE & FILL §J
A
JFNERAL PERMIT Previous permit #
�Ne_v []Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
sized 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
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Project Location: County ❑ Rules attached.
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❑ OEA ❑ HHF
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yes / no , PNA
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not sure yes
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yes kttached: yes
ng permit may be required by: h T 1)VI%1w, _ . ❑ See note on back regarding River Basin r
Local Planning Jurisdiction) _ (tAv\ X3%<- L,

2/18/20161 lJohn Graham/Lighthouse Marine John Graham Four Oaks Bank 1688 5200.00 GP 64773D

.Applicant. (1,1,1Y\ C-ITAIUk"
Date: `a / ( g M./
NC Division of Coastal Mgt. Habitat Impact Comi
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.
(At
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Ex
res
restoration or
and/or temp
restoration or
ter
tem impacts
impact amount)tem
impacts)
arr
{ A /
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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 ❑

Date
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
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Name of Property Owner Applying for Permit:
Mailing Address:
CJ C.0- I�
I certify that I have authorized (agent) C/, 56 ? "—`— S
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) S �X w � l �� l /C"/c __) J �.
This certification is valid thru (date)
x
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4
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: c- 1,'% Al/�p- r "�✓� A,//t
Address of Property: C` Id
(Lot or Street #, Street or Road, City & County))
Agent's Name #: li�S ✓ ��,�� S Mailing Address: D -a
Agent's phone #: ?U5�- �3 ��� _S14// Z127-
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
C ' they are proposing. A description or drawing, with dimensions, must be provided with this letter.
S�I have no objections to this proposal. I have objections to this proposal.
C 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. Contact information for DCM offices is
available atntto:,iwww.nccoastaimanaaement.neinwenicaystart-lisana 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, boat ramp, 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.)
do wish to waive the 15' setback requirement.
( I do not wish to waive the 15' setback requirement.
(Property Owner Owner Information)
Signature
(Riparian Property Owner Information)
Signature
Print nr Tvnc Almmv

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151520000046720341
r: Tuesday, January 19, 2016
'n g Information Available Actions
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Features: Text Updates
Certified MaiITM Return Receipt
See tracking for related item: 9590940304355163070630 Email Updates
STATUS OF ITEM
LOCATION
:03 Delivered SHALLOTTE, NC 28470
ed at 12:03 prn on ,January 19, 2016 in SHRLLOTTE, NC 28470.

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CHAR LESTON, WV 25350
BARBOURSVILLE, WV 25504
BARBOURSVILLE, WV 25504
BARBOURSVILLE, WV 25504
CHARLESTON, WV 25350
CHARLOTTE, NC 28228
CHARLOTTE, NC 28228
SHARLOTTE, NC 28470
SHALLOTTE, NC 28470
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