66608D - Harrison

-'CAMA / ❑ DREDGE & FILL i 1 l�
GENERAL PERMIT Previou s permit # A B
7New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
)rized by the State of North Carolina, Department of Environment and Natural Resources /q / % 2 C,�
Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
Rules faached.
nt Name Project Location: County
'/ q '/ Street Address/ State Road/ Lot #(s)
11S' P.�_e State A-'4-'- ZIP .
i
() E;,M ail
Subdivision (�/j,(�05
Al Go' �,.. 1''t�
zed Agent_ u ��4 City �'� / ZIP ,/4
❑ CW ?3w PTA ❑ ES ❑ PTS Phone # ( �--- Wver Basin 1%(
� 1�
❑ OEA ❑ HHF -' ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body
❑ PWS: �
yesno PNA esJ no Closest Maj. Wtr. Body
)f Project/ Activity
ock) length
'latform(s)
g Platform(s).- y r
pier(s),/! ���K2 Y
length
ufnber
ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
imp
wse%'Qoatlift l ��
Bulldozing
ine Length
not sure yes
:)rium: n/a yes
yes
Attached: yes no.
ling permit may be required by:
Local Planning Jurisdiction)
(Scale: J
❑ See note on back regarding River Basin

NC De "Sion of Coastal .Mgt. Habitat impact Computer Sneer
Applicant: ( t! S
Date: lov�the��HABITJkturbances
Describe for the application.
match the name, and units of measurement
found in your
Habitat code sheet.
All values should
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FII
(Applied for.
(Anticipated final
(Applied for.
Disturbance
(Ai
dis
DISTURB TYPE
Disturbance.total
includes any
disturbance.
Excludes any
total includes .
Ex
Habitat Name Choose One
anticipated
restoration
any anticipated
re:
restoration or
ternimpacts)—impact
and/or temp
amount
restoration or
ternirri acts
ter
an
❑ Other
Dredge ❑ Fill ❑ Both
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge [j Fill F1. Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ I I
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑. Fill ❑ Both ❑ Other ❑
Dredge [IFill ❑ Both [IOther El
x
,
�'aa:

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date /11
Name of Property Owner Applying for Permit:
Mailing Address:
I& V,
I certify that I have authorized (agent) (T ( 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) 4C1r ►�� Cl�,i-
,!
This certification is valid thru (date) w
A
Property Owner Signature

;9/(O/lr
CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner /N1 ,�j'AT l p,✓
Address of Property: 1,07- ay CA01- /VC ZM60 o'
(Lot or Street #, Street or Road, City & County)
Agent's Name #:
-�bj/r
GAL"✓
Mailing Address: _�6 ,t,q,� y,QI,-",r
Agent's phone #:
_ 20 -,
3.76 —V %
cf/"a9�i� .ft �� �!cJ
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.
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 Coastal Management
(DCM) in writing within 10 days of receipt of this notice. Contact information for DCM offices is
availableathtto.*11,,y.fvi'.,7ccoastainianaaemen.,7etiv,;eblcrt?ls?ar`-lis£inoorbycalling1-888-4RCOAST.
No response is considered the same as no objection if you have been nodded 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
Pri t or Type Name
M ll' & .4d./IgJJ
(Riparian Property Owner Information)
Signature v
e A0��
Print or Type Name
3-5 6ILQ
"711
-
�.

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: %�_,'/ ,�,qAX, fo, i
Address of Property: 40
(Lot or Street #, Street or Road, City & County)
Agent's Name #: cU7, � Mailing Address: -A ,9
Agent's phone #: IWO - J77�. �9 % /'�< l /fs!y /V G 19
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.
_Z/ 1 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 Coastal Management
(DC&V in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at litta.,I1,v►rrut.,7ccoasrafrnanaaenierf.,-7erl►, eblcri7lstaa"f listing orby 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.)
I do wish to waive the 15' setback requirement.
(,.do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
i 7 �i 11A44 �o, •
Print or Type Name I
l,f-;I;.,y A-;.V,v�
(Riparian PropfflyOwner Information)
&96ture
Prinror Type Name T
'-KJ& ��k
Mall/fig A Ahcoo

_y14,&d
i
3
f d/, r 16
301
�-c i r e