66591D - Roycroft

CAMA / ❑ DREDGE & FILL � -'LV//I
1`
JE�iiERAL PERMIT
Previous Permit # A B
New ❑Modification ❑Complete Reissue ❑Partial
Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources j r'
coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC � - � 1 U0
Name b� �'l'�I 1'�0 �
El Rules attached.
Project Location:
Project (V-y
it
County
Street Address/ Statte"Road/ Lot #(s)
CA- V-' � State `��I�
✓l �I r\ vti(a-A- L,-a V"k-
lJ Q 7 9" - Q E-Mail '_
Subdivisions_
Eed Agent
,
City ' 1 Val: ( U ZIP
o
❑ CW © EW ❑PTA ->AS
E"V
Phone # 1 ) l �� T� �c�1 RiverBasin
❑ OEA ElHHF ❑ IH ❑ URA El N/A
Adj. Wtr. Body f j +C� nvt, at'
jl
❑ PWS:
WS:no)
yes PNA yes no
Closest Maj. Wtr. Body iAjtA)
f Project/ Activity
� r;•� 1'v �'vv
Kk) length
latform(s)
angth
Lrnber
id/ Ikiprap length
g distance offshore Q�—
ax distance offshore U
hannel
iulldozing
rip
n
n
n
ing permit may be required by: Ui'�4\MZ ❑ See note on back regarding River Basin r
Local Planning jurisdiction) _ ,
(Scale:' Il
J

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant: (c n
Date: V cj Ms/o\,o
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
Fit
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex(
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
temp impacts)
impact amount
temp impacts)
am
Dredge ❑ Fill Q4 Both ❑ Other ❑
(p J 00
tX 7 00
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C Qv—p
Mailing Address:
`Y'° -7 f � �i����o � Lance
Phone Number: q/ 0 — -Z- 6 8-5--(o
Email Address: J- & a4nq C_ , n-e4-
I certify that I have authorized le_i-i
(PA V 7/0- cjt8-8
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: �y 04Kea d: ►n�
at my property located at
in County.
1 furthermore certify that I am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signat e
Car-D H o v Gr
Print or Type 16me
Oy) it e
'r;41-

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to1�t,�Q_ 's
property located at o O L 1� (N_ ��c opert owner)
on �i�/in
/J r Y,�� ddress, Lot, BJ�cl�o�j
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locatio
I have no objection to this proposal.
I have objections to this proposal,
utbLKIPTtON AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing)
C�EGr AT`7—Aco 1Gv !
Of, cuuG P polo'D rq 40
46 Mas` h�-�:.. � gaff p--�
krgld 4
° F r,'e ra,
vtF6-Aec
a P. W. Z♦�. t< °
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set back
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to wain
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 Information) (Adjacent Pr perty Owner Information)
Gl % � 0�
Signature Signal ure
9-coo �., L LP
PrinfOr T p� Name r �� Print or Type Name
did? L "` 6-k- A.)Cod K*- ZSod W.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to _�a�� ��L r- -Q s
,I _ , (Name of P oaerty Ownerl
property located at
(KOdress, Lot, B o k, Rp ad tcj on � �� � r 'il�✓ in - ` �ic//o - ,,aianrai'c4C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above locat
Ixr / I 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
J Ee' .4T7-i4C14 677) f
I
a ri d
10 lacy i• f '
�' V' Jd 4
o P ,r,'P raP
L r' b v l Alt
a I- r flee 6 R., k
4E Z a-.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set bai
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to w,
the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
&I—LZ I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
ML
Si Mture f
J Signature I
CGl'-e / tea c00l�/ b r4 r �t/i� G �'E i i,4 /�'i
Print or Type Name Print or Type Name
'ld? L -e`.CA*- lveod AN16 Z J 1MAZXn,c I&

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