66682D - Spear

Project Location: County DIVA Jam%
B
Street Address/ State Road/ Lot #(s)
5 L4-\C...h
Subdivision
Ci Vti" P�� ZIP
River Basin
Phone #
Adj. Wtr. Body (nat
Closest Maj. Wtr. Body
10A,hA
CAMA / ❑ DREDGE & FILL V f
PENERAL PERMIT
I
flew C,7Modification ❑Complete Reissue ❑Partial eissue
A
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources •'' ,� j ' O b
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC t `❑ Rules attached.
Names
1
e\�
�A �� Stater ZIP _
E-Mail
rr
� �Y ��"'Tcs hope
ed Agent
Y-A
❑ CW
'mow rA ❑ ES o PITS
❑ OEA
/❑ HHF ❑ IH ❑ URA ❑ N/A
❑ PWS:
4o)
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PNA /
yes /
yes iho j
f Project/ Activity ko 1 01 Q X
1'�1-k1i'iiQaV1
ck)length �vI
atform(s) r'
1
Platform(s)
)ier(s)
mgth
amber
id/ Riprap length_
g distance offshore
ax distance offshor,
:hannel
ra1AV , cAhd,
(Scale:
❑ing penmm n iay vo 1 cyun o wy-
P I nrnl Planning lurisdiction) _ _ i I 1 1
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NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant J�� 5. �� ►� Permit #: (�
Date: G-
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
DISTURB TYPE Disturbance total
Habitat Name
disturbance.
Disturbance
disturbance.
Choose One includes any
Excludes any
total includes
Excludes any
anticipated
restoration
any anticipated
restoration and/oi
restoration or
and/or temp
restoration or
temp impact
Dredge ❑ Fill ❑ Both ❑ Other X
I Dredge ❑ Fill ❑ Both ❑ Oth
FoER: COMPLETE THIS SECTION
mplete items 1, 2, and 3.
A Signaturx
nt your name and address on the reverse
that we can return the card to you.
a
ach this card to the back of the mailpiece,
B eceived
on the front if space permits.
n r-.�Q
cle Addressed to:
Wxk,
We4;,76fi Si
011
;CI ❑ Agent
u-a- ❑Addressee
by (Printed Name) pate of Delivery
Is delivery ad different m ftWi 1 ❑ Yes
If YES, ent d__'ery addre s below: o
C.
T
'IIIII I'II I�I I II II II III II III'II I I I I II I I III3.
service Type
❑ Adult Signature
0 Priority
p
❑ Registered MailTMess®
9590 9402 1364 5285 8915 10
❑ Adult Signature Restricted Delivery
❑ Certified Mal®
0 Certified Mail Restricted Delivery
❑
D.Irvery Registered Mail Restricted
Return
Receipt for
❑ Collect on Delivery Merchandise
❑ Collect on Delivery Restricted Delivery ❑ Signature Confirmation^"
de Number (Transfer from service label)
7 015 0920 0000
7 610 3946 eery
Signature Confirmation
Restricted Delivery
m 3811, July 2015 PSN 7530-02-000-9053
_
Domestic Return Receipt
■ Complete items 1, 2, and 3.
■ Print your.name and address on the reverse
so that we can return the card to you. C-=
■ Attach this card to the back of the mailpiece,
❑ Agent
❑ Addressee
C. Date of Delivery
1. Article Addressed to:
�1 A — /1

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
IcCrory Braxton C. Davis John E. Skvarla, III
ernor Director Secretary
AGENT AUTHORIZATION FORM
Date:
of Property Owner Applying for Permit: Nam�uthorized A ent for this project:
is Mailing Address:
Number o
Agent's Mailing Address: _
Phone Number (
y that I have authorized the agent listed above to act on my behalf, for the purpose of applying
J obtaining all CAMA Permits necessary tor1install or construct the following (activity): i t�
iy property located at �� �^ Si — C-T-1 C.-
ertification is valid thru (date)
(�ropertner Signature Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property:
(Lot or Street #, Street or Road)
(City and County)
hereby certify that I own property a Jacent to the above -referenced property. The indi
applying for this permit has described to. me as shown on the attached drawing the developmei
are proposing. A description or drawing, with dimensions, should be provided with this let
-� I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of C
Management, 127 'cardinal Drive Extension, Wilmington, INC 23405 or call 910-79(
within 10 days -of receipt of this notice. No response is considered the same as no objec
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, break--svater, boat house or boat lift mus
bck a minimum distance of 15' from my area of riparian access -unless waived by me.
wish to waive the.setback,,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I ddo�not wish to waive the 15' setback requirement.

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Individual Applyina For Permit:
Address of Property:
0 j
(Lot or Street #, Street or Road)
nM&6 _-L5 L P.A� SI '!� tom. S u--i i c
(City and County)
hereby certify that I own property adjacent to the above -referenced property. The indi,
applying for this permit has described tome as shown on the attached drawing the developmer
are proposina. A description or drawing, with dimensions, should be provided with this lets
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of C
Management, 127 'Cardinal Drive Extension, Wilmington, INC 23405 or call 910-796
within 10 dars-of receipt of this notice. No response is considered the same as no objec
you have been notified by Certified Mail.
WAIVER SECTIO.N
I understand that a pier, dock, mooring pilings, breakivater,�boat house or boat lift muss
bck a minimum distance of 15' from my area of riparian access - unless waived by me.
wish to waive the.setback,,you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement.
rl G I do not wish to waive the 1 5' setback requirement.
Sip Na ate

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