66315D - Hart

2CAMA-� ❑ DREDGE & FILL nC/v �/J l (
3ENERAL PERMIT / S
New ❑Modification ❑Complete Reissue ❑Partial Reissue
sized by the State of North Carolina, Department of Environment and Natural Resources
Zoastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
it
! h;4, StateW—' ZIP 40
E-!Mail
:ed Agent
1.. O ,ACt4
� J iV GrJV1oQ
❑ CW
❑ EW PTA ❑ ES ❑ PTS
❑ OEA
❑ HHF /❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no
PNA yes / no)
f Project/ Activity I ,"+Ir`l '
)ck) length
latform(s) GT��
Platform(s) x 1 6
>ier(s)
:ngth
1Sber
Riprap length
g distance offshore
ax dis4nce offshore
hannel '\
ibic
np.
use/
lulldozing
ie Length "If 7U
not sure yes
rium: n/a yes 4f no
Yes e-Q
A B
Previous permit #
Date previous permit issued
❑ Rules attached.
Project Location: County
Street Address/ State Road/ Lot #(s)
()-to wr
Subdivision , ��
City i "-�i+-�'C ZIP �5
Phone # ( ) River Basin
Adj. Wtr. Body 3(AM
�'rt.�
Closest Maj. Wtr. Body ��: O0,1.
(Scale: V=
Attached: �,�fes
ing permit may be required by:
Local Planning jurisdiction)
❑ See note on back regarding River Basin r

NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant:
Date:
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
MIS
(Applied for.
(Anticipated final
(Applied for.
(An
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
dist
Exc
Habitat Name
Choose One
anticipated
restoration
any anticipated
rest
restoration or
and/ortemp
restoration or
terr
tern impacts)
impact amount
temp impacts)
am
f CJ
C/
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 ❑

NCDEHR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Pat McCrory Braxton C. Davis
Govemor Director
John E. Skvarl<
Secretary
AGENT AUTHORIZATION FORM
Date:
Name of Property owner Applying for Permit: Name of Authorized Agent for this project:
Owner's !Mailing Address:
1 DDeXJ�
IA ti� 2; a 44 N ,
Phone Number 3s3- S 5
Agent's wiling Address:
L�Q h-�-h fl � s fYl �.;� i t1►° ���
"?
SL,rJ C� 6�)C g
qq�
Phone Number " to 94
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity)
c
For my property located at 10 y o dw • AU= • a 12Kw I12 e. tj C-
This certification is valid thru (date)
Property owner Signature Date-' i.-IVED
DCM WILMINGTON, NC

93622747 Duke Energy
Duke Energy 02:14:02 p m. 03-22-2016 2 /2
ADJACSNT RIPARIAN PROPERTY OWNER STATEMENT
i haraby cortify that I own proparty adjacont to - a�b�t R- 14-- e Ic
(Nafnee of Propertv Owner)
property located at 10 q God 01.1 A,
(Address, La
on Tb� �a:1 S'o��-J� in
(Waterbody)
Block, Road, etc. n C
(City(Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca71 have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
RECEIVED
DCM WILMINGTON, NC
APR 12 2016
WAIVER. SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
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) (Adjacent Property Owner Information)
SignaturreL
13"11
Print or fy-pb Name
Ro flag Jo2Y
Mailing Address
G . Iry ss.-+ i/ , NZ ,
Pfintr Type Name
v 6ov 7SG
marun flaaresb
/ l 1 Al C
citrs-iat9ilip J
,. ...�,.. ... " '. 4 Est �_P...r.
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ADJ6CENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 2dlJoy R. LIXr-t 's
(Name of Property Owner)
property located at 1 o u Go a..) t- Ay —
(Address, Lot, Block, Road, etc.)
on in TQp 1,1 , N.C.
(Waterbody) (Cityrrown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca0 .
1 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)
?.Q0a-6c FLoPfi�S 'Do- k , 13ECE1
0CM
WILMIM
All� �Q �i}oi.►r. �.a { Low�i.•� l�oc1'. , APR 12
1j1A eve, o- a-i�-to.,j �'v.v 41rb- w a�-•- �..� e� �,.v.o.i ,
5 W.ii b..f +. get- 6-- L:%;+
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or grain
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.)
,..czzzzmw�
,* 1 do wish to waive the 16 setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
4, Sie ��~
Hebb„ (k. )d..rt
Print or Type Name
Po 1% 7 o z Y_ 4 n..
Malting Address
(Adjacent Property Owner Information)
J
Signature*
�rs� (rw�l��ker
Print or Type Name
t rob
Malting Address

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