67251D - Tioga, LLC

]CAMA / ❑ DREDGE & FILL A B
GENERAL PERMIT Previous permit#
New ❑Modification [-]Complete Reissue El Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources 'ZO�
:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC :)� .
❑ Rules attached. v
t Name 1 C7 �"l� t 0 .7�� b� Project Location: County- 17 ,0 ,
Street Address/ State Road/ Lot #(s)
X5"t ' V i'`Q. State kK ZIP_ ►- "bO y CO— Cv�ec K
(U) Z-1 1 ! �5 VLE-Mail ' ^/ _ Subdivision
ed Agent !v \� i YA C G1/1G ,y4 City iC ��6 i ly ZIP Z g 4 [
❑ CW XEW PTA ❑ ES ❑ PTS Phone # ( ) River Basin C. F
❑ OEA ❑ HHF ❑ N ❑ URA ❑ N/A Adj. Wtr. Body at
, r
ElPWS:
yes /� PNA es no Closest Maj. Wtr. Body "iR
' Project/ Activity n V CA-i� 01 ill 1'In „V`•
avi (Scale:
ck)length -
itform(s)
Platform(s) , �14— -
igth
nber
i/ RiPrap le gih
distance ffshore
x distan offshore .`
_ f
annel
iic ds
ip
'!
illdozing
a rzt w, >P ti 15 - ate-- 4 J 4- 71
Length
not sure yes no, -
um: n/a yes n� 9
� i ,
yes nd
0
atached: yes no + �—
ig permit may be required by: 2 l-0t1 11(KI C �n S
-ocal Planning jurisdiction)
L`
❑ See note on back regarding River Basin rt

)(CAMA / - DREE)GB & FILL / \� =Q 67251 A B C
GENERAL PERMIT Previous permit #
11
New 7—Modification LComplete Reissue Partial Reissue Date previous permit issued
uthorized by the State of North Carolina. Department of Environment and Natural Resources ��SS h�
the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC 0 ti
^�'� / ^Rules attached.
1Acant Namet CJ 61 U'(1 L 0 JC�'� 6�L1,% Project Location: County �►r11�(17Rules ached,
cress-r ` t ! _. Street Address/ State Road/ Lot #(s)�
�a+r Af— 1.4 State&X , , ZIP_ 1 . Lis a,�-'
me # ) 1— is 94-Mail Subdivision _
horized Agent' v 2 Y_na,�" C City �G7"}f �1 ZPZ�
acted Cw A P7 S Phone # (, ,n) _ River Basin
' OFA ' ; HHF ':- IH USA N/A
(s). Pws: Adj. Wtr. Body_ J/I�hJ G ____ mar
W_ es / o PNA , no Closest Maj. Wtr. Body—_._.� __-�-
y �J (�?
p - of Project/ Activity
ee(dock) length."„ t)-^% 1
Ked PIddo.(5) 1i , x i i
Z , Dazing Plazform(s) _
''Ter p�er(s)_"___
-oin length
number _
ilkhead/ Riprap le gth
avg distance ffshore,v T
maxdistan offshore_
sin. channel J
tat ramp L -. ______,___ AV
tact �lid6Zing...-_.
1-6
boAk M)r! _ —15 ' X4417'
oreline Length ._7 -S ax ���-- --
kv- not sure yes
x-dwrium: n/a yes
:otos: yes r
giver Attached no
less �toe ttle
Y,
co 3
(Scale: j °~
N
Oe
$• � ��jV
yes j
wilding permit may be required by l 1i;1.(,i�' (AA ' 11'� . 'v�l s See note on back regarding River Basin rule:
cote Local Planning Jurisdiction) n e
)tes/ Special Conditions }� S f17�i`t i� i;�^ Chili act a#'f-w ' iM6 tCCA Gix .r' jWw.ji

- NC Division of coastal Mgt. Habitat Impact,computer Sheet
Applicant: T-ce�G ubc CA Scc)f-/- Permit #: (� -77 �--�
Date: 1` 16
�77
t I'
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.
(Antidpated final
(Applied for..
(Anticipated final
Habitat Name
DISTURB
TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Choose One
includes any
Excludes any
total in
Excludes any
anticipated
restoration
any anticipated
restoration and/or
restoration or
and(or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts.)
amount)
�
Dredge ❑
Fill ❑
Both ❑
Other
rn
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other [I
Dredge.❑
Fill ❑
Both ❑
Other []
Dredge ❑
Fill ❑
Both [I
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 ❑
Fill❑
Both ❑
Other ❑ill
E
❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑
Dredge ❑
Fill ❑
Both ❑
Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: s �
Mailing Address: ru r 7T2
Cat-s/��
Phone Number:
Email Address:
I certify that I have authorized
y -- 15-9-el
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: (rGL�d�n Y- 61*11,11 16012-1/—
1 u vnCil / f 51(/�(/l� Cw, r V 1-y S�/rU���/L ��A
at my property located at
in f i Q�C/ County.
1 furthermore certify that 1 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:
r
i a
f-'e4+ (f—�o(Zot-i
Print or Type Name
Title

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property:
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Izll Mailing Address:
Agent's phone #: - 1 t)) �-00 —6 6 lO l.Ji M ,k)L kG((
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.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis beingproposed, you mustnotify the Division of Coastal Management
(DCM) in wilting within 10 days of receipt of this notice. Contact information for DCM offices is
available at:httpJ/www.nccoastalmanagement.net/web/cm/sta;::-listing orby calling 1-8884RCOAST.
No response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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)
Signature l/
Print or Type Name
-(Riparian Property Owner Information)
Signatu
& al /°Z�7e-, S
Print or Type Name
2// ,C1,S

on the reverse
d to you.
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D. Is delivery address different from item 1? ❑ e:
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
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❑ Certified Mail®
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Delivery
❑ Return Receipt for
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Merchandise
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0 Signature Confirmation-
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D. Is delivery address different from item 1? ❑ Ye
(/ If YES, enter delivery address below: o
I
3. Service Type
❑ Priority Mail Express®
IIII I'IIII
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❑ Adult Signature
❑ Adult Signature Restricted Delivery
❑ Registered Mail-
❑ Registered Mail Restricted
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❑ Certified Mail®
❑ Certified Mail Restricted Delivery
Delivery
❑ Return Recelpt for
❑ Collect on Delivery
Merchandise
:e label)
❑ Collect on Delivery Restricted Delivery
0 Signature Confirmation*
101 3548 0039 iestricted Delivery
❑ Signature Confirmation
Restricted Delivery
60-02- 00-9053
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