67108D - Kami

ICAMA / ❑ DREDGE & FILL
GENERAL PERMIT
New ❑Modification ❑Complete Reissue El Partial Reissue
67108 A B
Previous permit #
Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
I j kn1kules attached.
t Name VI 407 Project Location: County
ti iwl Street Address/ State Road/ fLot #(s) Of
Nf l ii, 43 lhi State N& rZIPle %� � J l 11;1 tl XV
` (IRA) —z1h E-Mail 4+ t kWidt" Subdivision 5 G j !60
:ed Agent G1/7 City 1/1,444,1-71`1!* ZIP
ElCV1l t5 Ew A ❑ ES ❑ PTS Phone # () r '2 River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
Adj. Wtr. Body S Kh /Y[X- (naiJi
El PWS:
yes %no PNA / no Closest Maj. Wtr. Body :ru'
r Project/ Activity
ck) length
atform(s)
Platform(s)
ier(s)
ngth
tuber
d/ Riprap length
distance offsho _
uc distance offsh re
cannel
tic yards
np
/ Boatlift
ium: n/a yes n
es i
7 5-Alt //e? 1/
(Scale: I �� •
k Zoe
ye no
oe Z
ng permit may be required by: ICJ . 1 hSGtlt �lYf S4�i
❑ See note on back regarding River Basin n
Local Planning jurisdiction)

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
V4`/''ter
Applicant; 1.C1 USG Permit #:/©O
Date:
Poe
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 .
FINAL feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
Habitat Name
DISTURB
TYPE
Disturbance total
distufiance.
Disturbance
disturbance.
Choose One
includes any
Exclu.des•any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts)
I amount
Dredge ❑
Fill ❑
.1
Both ❑ Other
Dredge ❑
Fill ❑
Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑ Other ❑
Dredge ❑
Fill ❑
Both ❑ Other ❑

A��
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
John E. Skvarla, III
Secretary
N.G. Division of Coastal Management
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: Name of Authorized Agent for this project:
-,u Owner's Mailing Address:
_&Ant Sh'i n n l,oaa( Re(
, 0(, Boa
Email: VIA tk-M ® �1'IX1 . 01'
Phone (� 4 4s_0 - . c1.4-
Agent's Mailing Address:
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):
For my property located at '� "' J+
0, i
%,,,,QW
��,
�i
\ This certification is valid, I yeaFfrflm (date) ' �� ��-- ✓ /�
Property Owner Signature Dr

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner: zL.
l i {;
1 /��C1 /i 1� `t' h t .,�i
Address of Property: L % i'i r +� i (l -r, /�+L L i
0 (Lot
, or Street #, Street or Aoad, City ou ))
Agent's Name* �� f !' ��l �ii Mailing Address:
Agent's phone #: [phone]' 3D4.�, IPA�
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 ar roposing. A description or drawing with dimensions, must be provided with this letter.
I ha a no objections to this proposal. I have objections to this proposal.
N you have /actions to what is being proposed, you must notify the Division of Coastal Management (DCM) in
writing within 10 days o1 receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at (910) 7W7215. No response is
considered the same as no objection N you have been notified by Cartllled Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
(Propertlfbwnerinforination) ct<nt P rty Owner Inf lion)
Si
7ure
Print or Type Name Print or Type N e r
Mailing Address Madipgt 4dd►ess
n i lr I
City/State/Zi C tat c
4 ,-1 /I , ) -A 7 V'r alp I � 77 `, '..

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
a
Name of Property Owner:
, ,,f Z
Address of Property: i.i;,z� l % 'l ��i � i t
(Lot or Street #, Street or oad, City 8 ounty)
Agent's Name #: l_ PILa), ), Mailing Address:
Agent's phone #: / 1'v, iC' 7,�/
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.
ha a no objections to this proposal. I have objections to this proposal.
" e r:+WA'I- gpTi" 00stu
N you have jections to what is being proposed you must notify the Dtvislon of Coastal Management (DCM) in
writing within 10 days of receipt of this notice. Correspondence should be malted to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if you have been no~ by Certllled Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
(Prop wne)lnfo ation)
Si re
P 'nt or Type Name
nn L.-X of P-Vf
Mailing Address
CttylStatelZifi
(Adjacent Prop Owner Information)
Signature
4'VI ;1e / , �'?r,
Print or Type Name
6. 5xIit�J
Mailing Address
l/`--, ) nrn , -r, � 07,
City/State/Zip
/-, 1 1 /i 4-'f) '-) n a-)
/f". l2 C;) - i- ry/i

5U
_- -- 5GG025'59"E ---- MA
G2.76DEED
NOTE:
/ TH15 MAP AND FIELD 5URVEY WERE MADE S/� IN ZON
FOR THE EXCLU51VE U5E OF THE PER50N, ° MAI
LLJ PER5ON5, OR ENTITY NAMED IN THE
/ CERTIFICATION HEREON AND MAY ESE U5ED \`9 COM
_N cc DY 5AME FOR ANY PURP05E REQUIRED 6 �C DAT
poll,���//� off/ IA5FREGARDSN TITLE,
L , THEIR (IT5) OWNER5HIP OR
A5 \
IN5URANCE REQUIREMENTS OF ANY PUBLIC \
2/ OR GOVERNMENTAL AGENCY.
3 ` / RIPARIAN CORRIDOR A5 PER EXHIBIT A
IN DEED BOOK 1223, PG 4 15 1 1 17 51'
47 ° 13'37t
co/
N44 °5 b �Co�
4f) if)
� C
W° FLOATING 90
`N co DOCK
m
�' __�N . OVERC� TIE LINE
z / G. 588°25'50"W N56°05 56"VI
G7.54'
5 Se \
DR'5 / s MP
DOCK NEIGHBOR'S \
"ADD -ON" \ DECK WOODEN
I FLOATING DOCK BULKHEAD
— � 4 --
-83
559023'53"E
�O
UPLAND IMPROVE
\illT (="t_'UA/A