66322D - Hobart

-1CAMA / ❑ DREDGE & FILL LV �b� 6�� A
�ENEFi`i4L PERMIT Previous permit# --4L
7 slew ❑ Modification El Complete Reissue Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources �- l
:oastal Resouill Commission in an agea of environmental concern pursuant to I SA NCAC
n�Rules a 'hed.
t Name rv"'l a ✓ Project Location: County
Street Add
u ress/ State Road/ Lot #(s)
State. ZIP �C) ��3 tz4ve
Ojam zt`h E-Mail Subdivision
ed Agent , �// d a �t �. (. &/t _ City ZIP
❑ CW ❑ EW hrm ❑ ES ❑ PTS Phone # ( �River Basin
❑ OEA ❑ HHF ❑ IH ❑ URA ❑ WA Adj. Wtr. Body
❑ PWS:
yes / no PNA yes / n6�
Closest Maj. Wtr. Body
f Project/ Activity
ck)Jength
atform(s)
Platform(
ier(s)
ngth
tuber
d/ Riprap length
g distance offshore_
uc distance offshore
cannel
bic yards
np
not sure yes
ium: n/a yes c�P
yes t!fio7
kttached: es ? no
ng permit may be required by
Local Planning jurisdiction)
(Scale:
c
❑ See note on back regarding River Basin r

NC (Division of Coastal .Mgt- Habitat Impact- Goenpu er
:)plicant:
ate:— f
ascribe below the HABITAT disturbances for the application.
II values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL. Sq. Ft.
final
TOTAL Feet
(Applied for.
FINAL Feet
(Anticipated fins
(Applied for.
Disturbance.total
(Anticipated
disturbance.
Disturbance
disturbance.
abitat Name
DISTURB TYPE
Choose One
. includes any
anticipated
Excludes any
restoration
total includes .
any anticipated
Excludes any
restoration and/
restoration or
tam impacts)._ -,impact
and/or temp
amount
restoration or
ternirti acts)
temp impact
amount
Dredge ❑ Fill ❑ Both ❑ Other J `[
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ElBoth ❑ Other [I
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge. ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other El

e��
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date ` j12—
N
of Property Owner Applying for Permit:
&i24/UGt—'- /--t 0154
Mailing Address:
PV_/U if
!��►•t N C 2 v
I certify that I have authorized (agent) � lc - to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 6Ybe 4,
at (my property located at) lc ���� ✓`�
/VC
^ n
This certification is valid thru (date) j`z"e �Gr
4"'� e� - -4oif � L/1�_2_31�91-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Frfm*- ffekatr- "
property located at
(Name of Property Owner)
Z i r,r s Iq oc-
Block, Road, etc.)
I
on S o./ , in N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: '7 hr- -311� ? 21Mailing Address: 2- C-t
da � Ivc, z g-1'+3
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
p6t) — I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
L� e e "e)
(Information for Property Owner Applying
for Permit)
(Riparian Property Owner Information)
Mailing Address
Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 4 } t- is
(Name of Property Owner)
property located at
(Loi� Block, Road, etc.)
on fc � , in % Lam," JK I / , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 710 36 -7 Z 191 Mailing Address: '72
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature

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