66609D - Taylor

CAMA / ❑ DREDGE & FILL A B i
'iENERAL PERMIT Previous permit # �• '"
Date previous permit issued
New ❑Modification ❑Complete Reissue El Partial Reissue P P
zed by the State of North Carolina, Department of Environment and Natural Resources
:)astal Resources Commission in an areas yof environmental concern pursuant to I SA NCACi�0 Rules attached.
Name �. ^ j� - �`�� Project Location: County
Street Address/ State Road/ Lot #(s)
C�tec� N f/ 1 (_ C. State Ni✓ ZIP
E-Mail Subdivision
Bd Agent c v\Sr-cCity J u1 1. iL ZIP
❑CW I�yPTA ❑ES ❑PTS Phone # (""j'-- River Basin
❑ OEA ❑ HHF /❑ IH ❑ URA ❑ N/A Adj. Wtr. Body
❑ PWS:
Closest Maj. Wtr. Body
yes no PNA Oyes no
Project/ Activity
(e:
NJ I
rkqmmuu'%29�-� I I I! ME lid EMEMINoikbw,
Platform(s)
ier(s) sL X i -7
ngth
mber
d/ Riprap length
g,oistance offshore
ax distance offshore
hannAl
ibic yards
use/ Boatlift
WIdozing h
.l
ne Length
)rium:
Jing permit may be required by: NA! 11 I ( (-;U --
Local Planning lurisdiction)
on back regarding River Basin

NC Division of Coastal MO. Habitat ImP21ict'COmPuter Sheet
Applicant:Pp�y ls-') L, 0
Date:
Describe below the HABITAT disturbances for the application.
All values should match the name, . and u . hits. of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
Fit
(Applied for.
(Anticipated final
(Applied for.
Disturbance
(Ar
disc
DISTURB TYPE
Disturbance.total
. includes any
disturbance.
Excludes any
total includes
Ex(
Habitat Name
Choose one
anticipated
restoration
any anticipated
res
restoration or
temp impacts)
and/or temp
impact amount
restoration or
temp i.ftipacts)
ten,
am
I b
Dredge El Fill El Both F1 Other
Dredge El
Fill 0
Both [I
Other ❑
Dredge []
Fill 1-1
Both F1
other 171
Dredge E] Fill 171 Both n Other 0
Dredge E]
Fill El
Both El
Other 0
DredgeEl
HIE]
Both [I
Other n
Dredge 0 Fill E] Both E]. Other 0
L

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date
Name of Property Owner Applying for Permit:
Mailing Address:
Z �, 2 � -,L-51
to.
I certify that I have authorized (agent) L,�J " ' to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) l"%a ,
at (my property located at) 4.eT
This certification is valid thru (date)
P
roperty Owner Signature Date

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Own
Address of Property:
Agent's Name#: _
Agent's phone <�`i°%;�
W
(Lot or Street #, Street or Road, City & County)
Mailing Address: 141.
m
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 p:1have
sing. A description or drawing with dimensions must be provided with this letter.
no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division or Coastal Management
(DCM) in writing within 90 days of receipt of this notice. Contact infonnation for DCM offices is
available at,,,:- if , ": -_ _ r`�:= _ _ �'` b : = _ :== 'c :J� _ `` orbit calling 9-888-4RCOAST.
NO response is considered the same as no objecfion if you have been noted by Cetir 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_
(p C3 _� 1 formation)
Si ature
Print or Type Name r
i � 0 ( w4 L <�►1c�► 1�
nvaa,.1a
(Ri an Propeeiy Owner I T rmation)
Si ature
Print or Type Name
nrarrr,ry �i�lclrca�

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner:
Address of Property: ���%Z✓�' �'.�'i/J ��ylv° �N�w
(Lot or Street #, Street or Road, City & County)
Agent's Name #: �� ! f �. Mailing Address:
Agent's phone #:
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 what is being proposed, you must notify the Division of Coastal Management
(DCM) in writfng within 10 days of receipt of this notice. Contact infonnation for DCM offices is
availableat, 1/'.w' - _s-:c— l :c C :�� _ �t�Ji :'lc / _;;�orbycalling 9-888-4RCOAST.
No response its considered the same as no objection if you have been notifred by Certirled 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.)
2ctI do wish to waive the 15' setback requirement.
l do not wish to waive the 15' setback requirement_
(PropertZQw r Information)
Signa�*e
Print or Type Name
(Riparian Pr erbj weer Information)
� �rE
Signature
)R, k17�f)�S
Print or Type Name
TO _r 0.1' C51 9'
ILfo./:..y A.h1�vo.a
Maliltry AUUttroo %
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