67241D - Taylor

CAMA / ❑ DREDGE & FILL N19 6724iENERAL PERMIT 11-301) A B
Previous permit # �
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued ;`�•
zed by the State of North Carolina, Department of Environment and Natural Resources
:)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC L
/\ � les attached.l,,,
Name ✓ / /� ✓ Project Location: County ! " JJV
Street Address/ Sta Z
/,L,,ott #(s)
Ci A State / Jc ZIP Z�%9 S ? i t c/y
-Mail Subdivision
d Agent IAI City L \l 4 L V ZIPZA'L-fl
❑ CW NEWT ❑ ES ❑ PTS Phone-* ( ) L Riyer Basin�n/,
❑ OEA ❑ HHF / ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body i�fj/1 �'�n ��)m
❑ PWS:
no PNA yes
Closes Maj. tr. Body v
Project/ Activity List O t"
<)length
form(s) -i
'latform(s)
w(s)
gth _
fiber r
ksPoprap length
�--
disWnce offshore
distice offshore
innel :b s
c yards
P i
e/ Boatlift
Ildozing
Length
i
not sure yes
im: n/a yes y n
— --�
E
YeS
ye no
ttached: MIA
/
fig permit may be required by:
Al .,Al
.:9V
.ocal Planning jurisdiction)
(Scale: ! n
❑ See note on back regarding River Basin ru

NC Division of Coastal .Mgt. Habitat impact- GO.Mputer Sheet
Applicant:
Date: rj Z �o
Describe below the HABITAT disturbances for the application.
Mt.'
found in your Habitat code she
All values should match the name, and units of measurement
-Sq.
FINAL. Sq. Ft.
TOTAL Feet
FIN
TOTAL Ft.
(Applied for.
(Anticipated final
(Applied for.
(Ant
di h
DISTURB TYPE
Disturbance.total
inclades any
disturbance.
Excludes any
Disturbance
total includes .
Exc
Habitat Name
Choose One
anticipated
restoration
any anticipated
restoration or
rest
tem
restoration or
tem impacts
and/or temp
im act amount
temph acts
am
Q(jib
Dredge ElFill ❑ 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 0
-

Name of Property Owner Requesting Permit: r"��
Mailing Address: �G�'i � `�7' -�
Phone Number:
Email Address:
certify that I have authorized
Agent I Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in 1�?c.af;/a �.� County.
I 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:
0
Si nature
ZS L- 7—W V 1,,,n ic'_
Print or Type Name
Grp ti L 2-
Title

DJACE T ROP—AMAN PROPERTY OWNER ST A T r-08EHT
I hereby certify that I own property adjacent to,
property located at
(address
on cf, in
pftterbody)
Nail of �o
Sou - r
Lots, Block, -R gd, etc
own and or County)
's
N.C.
The applicant has described to me, as shown below, the development proposed at the above location.
I have no objection to this proposal.
I have objections to this proposal.
DESCROPMM Ag�1010R DRAMMO OF PR®POMM DEVELOP"-MNIT
(Individual rproposffng developmmeng musg Oil In dlezcrriatlan bs6ovr or aggach a site drawMg-)
WAIVER SECTION
1 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.
(progeny Owner Inforrna`ai0n) (Adjacent Cwn0P lnf®rna�i®cl)
Sipelwe
S� t
Print or Type Print or Type N me/

®sACr-MT �I�ArsAW ppopERTy owNER STATENEN � `gam '
I hereby certify that I own property adjacent to c u ,s
(wee of 111n' �vaa�er�
property located at / `s' 3 F u� -U 5""C{-1 -
on I` l : r in N.C.
�(a ,�
(Waterb®dy) (C- own and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
-M6H_ I have no objection to this proposal_
I have objections to this proposal.
(lndividuall proposin_q developmeng MuS9 fell in description below or a9tach a site o9rawoa��I�
WANED SEC` DON
lings, breakater, boathouse, lift,
I understand that
Jer, dock, mooring nce of15' from my area oaf riparian an accr
ess unless waived byme.'back;n must be set
minimum distance (! you wish towa v,
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.
(Pir®cneQ Ing®emati®n) d"'0lj8'
c apt ';�^se�
` ';
s. p `��>
Type Print or Type Name
prileor101 Iq PU(

r" -7iy
-.0.4 wy
c -7" 7
h rx
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