66503D - Upright

CAMAr/'Q DREDGE &FILL I ` L /`':'T
ENERAL PERMIT Previous permit #
SNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
wized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC (JJ I • I�� C
❑ Rules attached.
it Name ()r h cl Project Location: County
�Q1 Street Address/ State Road/ Lot #(s)
A��(.✓�h�a, AL State,_ZIP 1C, `j `a L(LkJA 0�tIi Q
�gE-Mail Subdivision
Eed Agent ( Via i lT I S kyrr,0 lj M City S � C� I l U �(_ ZIP
❑ CW /fIEW PTA
ElOEA ❑ HHF ❑ IH
❑ PWS:
yes / no PNA yes no
f Project/ Activity
)ck) length (
latform(s) Yi
Platform(s)
)ier(s) +
__._........
:ngth
ember
id/ Riprap le h
g distance 6ffshore
ax distame offshore
hannsl
c /yards
np
ise/ Boatlift
iulldozing
QA+,h P
ie Length 5 0
not sure yes (5 1
-ium: n/a yes o
yes no
Attached: 0 no
ng permit may be required by
Local Planning jurisdiction)
.t
ElES ElPTS Phone # ( M ) a 09 - d River Basin G V Vw1
❑ UBA ❑ N/A Adj. Wtr. Body S 6. V (� V1 GV at j
Closest Maj. Wtr. Body Al W W
0
IV �\ �_f A n 41V)
❑ See note on back regarding River Basin r

NC Division of Coastal Mgt, Habitat Impact Con
Applicant: L'S 0l V 'I j
Date:
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
F
(Applied for.
(Anticipated final
(Applied for.
(,
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
d
Habitat Name
Choose One
includes any
Excludes any
total includes
E
anticipated
restoration
any anticipated
r
restoration or
and/or temp
restoration or
t
temp impacts)
impact amount
temp impacts
a
/
© Vv
Dredge ❑ Fill ❑ Both El Other
a Ll
agog,
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge 0 Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: kv r] 1 0 11f
Mailing Address: 0�c q E r Rd
Phone Number:
Email Address:
_ �' ■ I II 1
o-jai-0
nCxA I
I certify that I have authorized Chi ley Sf (f V ells ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Cj 0 C �.
at my property located at ((�3 L'CnC)1vY6t1'e- 'Dr, Sha 1621 " ' ,
in �i1S�t%i ��- 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:
Signa re
Print or Type Name
weer
Title

PR-08-2016 11:57AM FRC61-LOCUST ELEVENTARY [phone] T-690 P.002/002 F-620
HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(2 OR.4 PMW00P VGPrUNGSBOAT;YF?BG.ATTZr00SF)
>~ 1
I hereby certify that I own property adjacent to i ^_ is
(Name of P perty ner)
pitperty located at
(Lot, Block, Road, etc.)
011
on 1-? , N.C.
( aterlsody) (Tows and/or County)
Applicant's phone N:qL04 �rafflsig Address: rt.4 �d
rie &L_1
Ha 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 beck a minimum distance of fifteen feet (IS') from my area of riparian access unless
waived by me. (If you Kish to waive the setback, you must lititial the appropriate blank
below.)
1 do not wish to waive
I d2 wish to waive that setback requirement.
•�yr`7. ...... �+�� • r--•••r r r•r••rrrr-ra•r-.r-...rr•........r-rrrr-•wr-r._./..N�11-•rrr•r•-•-•
r
DESCRIPTION AND/OR DRAWING OR PROPOSE>a DEClPME1VT:
(To be fried in by individual proposing development)
(Information for Property Owncr Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
!/� I1 Signature
! f h Ir ► L.L,...�-� ne f
Pont nr Tvne Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own .property adjacent to s
2 da�
(NeofPro erty ner)
property located at Alio e
(Lot, Block, Road, etc.)
on r{ min , N.C.
(W terboody) (Town and or County) r
Applicant's phone #: /NA ailing Address:
f- k N C OG
l Ie has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal,
-----------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
C,-,e p- �
�-(-I-n--f-o-r--m--a-t-i-o--n--f-o--r--P--roperty Owner -Applying -
for Permit)
Mailing Address
41 b4 ,n &J-I- NJC- mo b )
�Y�Y��LdL4.3t------------------------------.
arian Property Owner Informatio
E
i
Signature
Print or Tvpe Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to U S AP
(Nampt Owner)
property located at
lwhda/e Dr
(Lot, Block, Road, etc.)
on 3a C, f-e , in �h�l 1 N.C.
( aterbody) (Town and/or County)
Applicant's phone #: Mailing Address:,:Z . 1561t-d a
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal.
-------------------------------------------------- ---------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by property owner proposing development)
J I G•ree}� .. �
W "p,6perfy
L41 fu -4 1 1-, —
----------------- ----- --------------------------------
(Information or Property Owner Applying
for Permit)
D,-$V tyllk-d 124
Mailing Address
`— (�w� X - ------------------------- ----
T- r-----------
(Riparian Property Owner Informa ion)
.Q_ C o% W V( 14 C D C-e 1, k /, ((, - �4 L T
Print or Tvne Name