67169D - Tucker

CA AA / ❑ DREDGE & FILL /'?a / :, A B
MNERAL PERMIT % ( Previous permit #
New ❑Modification El Complete Reissue El Partial Reissue Date previous permit issued
ized 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 Rules attached.
N aLeynj� � ?% Project Location: County
�. Street Address/ State Road/ Lot #(s)
ed Agent"
' r '•�
i . C
- 7
❑ CW ) (EW
Y PTA
❑ ES
❑ PTS
❑ OEA ❑ HHF
❑ IH
❑ UBA
❑ N/A
❑ PWS:
yes rno'e PNA (yes^ f no
S1
Project/ Activity
11 i�i 4'- /i
ck) length /
atform(s) io Y 14
Platform(s) 8, X ZU\
:ngth
ember
id/ Riprap length_
g distance offshore
ax distance offshor
I hannel /
ibic yards
mp
use/ BoaV
3ulldgiing
Subdivision --�
City �C ZIP
Phone # (_ )
River Basin �!
Adj. Wtr. Body v i (_ ti r..5 `(nat /f
Closest Maj. Wtr. Body
ne Length Q y $ Q T C
not sure (yes) no
v 't
xium: n/a yes no l
yes n -
Attached: yes no
ding permit may be required by:
P I oral Planning lurisdiction) i . ► _ _ _ 1 1 n
❑ See note on back regarding River Basin
A '"_ i_ n % i, - E.-a, I n Y

TIC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: ri f oxj TocJAc Permit #: 64-10 �
Date: o q I ©q'.
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and(or temp .
impact amount)
TOTAL Feet .
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
1
U L
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both 0 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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge[] Fill ❑ Both ❑ Other ❑ .
Dredge ❑. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both �] Other ❑
Dredge ❑ Fill ❑ Both .❑ Other 0

NCDETIR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
;rly Eaves Perdue Braxton C. Davis Dee Freeman
?rnor Director Secretary
AGENT AUTHORIZATION FORM
Date: 5Z•S - o2F)1(.D
of Property Owner Applying for Permit: Name of Authorized Agent for this project:
ALL i
is Mailing Address:
x 0-- 4M 531
Number (919) '9(4� - y33g
Agent's Mailing Addra-,-
5 2798 Sea Vista Dr.
Supply, NC 28111
CONSTRUCTION
Phone Number (N) q--7-1 — -ilvJ
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 to install or construct the following (activity):
y property located at 115 5. E 5 +-k` -5TI2CETI OrkK rSLprr►d Jy .e• o�t�'��
ertification is valid thru (date)
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATUFTIBOATHOOSE)
I hereby certify that I own property adjacent to 62E9 3 f WWI K. 1 it*Vz's
(Name of Property Owner)
property located at . 5 +-h STa E
(Lot, Block, Road, cte.)
'i d �S Cr��� L _, in k Loot ►mot cl , N.C.
on (Waterbody) (Town and/or County)
n �'3'3
, i
Applicant's phone €f:-1��'��- `"1 Mailing Address:_1130 �(�rn
��A e 7s3I
He has described to me, as shown below, the development he is proposing at that location, and, l
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I T) 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 not Msh to waive
I do wish to waive that setback requirement-
------ -------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
CD,V5.r&-u e I-ibAJ P12I)J-,EcT / ,���la4G� EXIST/NG-
c1�"Pe�jC `nn�R 12 'ute0 rn ors
(Information for Property Owner Applying
for Permit)
93o5 5A Le-m Oiz-
Mailing Address
(Riparian Property Owner Information)
Signature
Pratt or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIERIMOORING PILIIVGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to I`tUA S• t MAN K It 4ef-`s
(Name of Property Owner)
property located at � r-
��lZ�
(Lot, Block, Road, etc.)
on_ l gNviS CA-tJPrL K J:-5LJ'fkiJ ,N.C.
(Waterbody) (Town and/or County)
Applicant's phone H:R )Q• .6 4,53I Mailing Address: , 10 M �Q
�C
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (I 5� 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 not wish to waive
I do wish to waive that setback requirement.
----------------------------------------------_
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT.
(7o be filled in by individual proposing development)
L 5ft�ft
�o/?5"T K �e77� �iLe`�J ELT lWty'CL 'fk, "S i I'/V 6—
CPs ►� � 1Z��j �, [2�. rY1� n r5' --
(Information for Property Owner Applying
for Permit)
-830 1 -Sp►Lem biz,
Mailing Address
(Riparian Property Owner Information)
Signature
o2753cI
Print or I've Name

EXISTING STRUCTURE REPAIR -115 SE 5T" ST., OKI - TUCKER