66330D - Watson

ICAMA / ❑ DREDGE & FILL PA a `3L3' l . 66z?3(" A B
"'ENERAL PERMIT Previous permit#
!New ❑Modification El Complete Reissue ❑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 15A NCAC 6 � .
_ El Rules attached.
t Name�VVl D S k--���yy-hTgON� Project Location: County � E�
32--s oo L N Street Address/ State Road/ Lot #(s)
State C. ZIP
E-Mail Subdivision W'y CT'
ed Agent N I P
❑ CW XEW A PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes / no PNA no
I� /1C .h I`
Project/ Activity �. r;,
:k) length �,"
itform(s) _RL
Platform(s)
er(s)
igth
her
I/ �prap length_
disfgnce offshore
x distance offshore
annel
lic yards
ip
se/ Boatlift
Length _f
not sure yes
City 7q-hn P�2TEjN> zip /��-
Phone # ( ) t River Basin W
Adj. Wtr. Body 'i/t% W AG r
Closest Maj. Wtr. Body— To-5A-%L 0yK I t
um: n a yes ,
--- ..
Yes -.
,ttached:no
ig permit may be required by: N i�
(Sca0e. 'u e
❑ See note on back regarding River Basin
.ocal Planning jurisdiction)

Z/16/2016 2/19/20115 JoOn umnam/L1gnmOUSe Mann. Jonn C9ranam tour yaks tsanK 1699 $200.00 GY 54773D
2N8/2016 2H9/2016 Rick WesUJRW/RDW Inc Leslie Pagliari First Bank 1114 5400.00 GP 66189D l@5200
1 2/19/20161 RRebecca & David Watson Isame )First Citizens Bank 1 22071 $200.001GP 66330D

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NC Division of Coastal Mgt. Habitat impact Computer Sheet
Applicant: ,
Date: Z r l 6
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
FI
(Applied for.
(Anticipated final
(Applied for.
(A
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di;
Habitat Name
Choose One
includes any
Excludes any
total includes
Er
anticipated
restoration
any anticipated
re:
restoration or
and/ortemp
restoration or
ter
temp impacts)
impact amount)__temp
impacts)
an
Dredge ❑ Fill ❑ Both ❑ Othe
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑._ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Applying for Permit: Do'V d L,a ( --S a n
Mailing address: 32 S' �0!,waad
J40. 4o, d NL a 8'443
Phone Number: ql o a-r 4 S-74la
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of
at my property located at 325' -r>o9waa3 t_r1j ({-c�ymps4c.J Nr
in 7,4r%d!A County.
This certification is valid through
Date
(Property Owner Information)
ok
Signature
-'b fq •i ► D Lj 4 T S a'i
Print or Type Name
D wV.::Ad
Title
III c—I ,t

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to-DAg(D i 2ei3FCcA S or-i I
(Name of Property Owner)
property located at Z S �Dagwoc� L,,.)
(Address, Lot, Block, Road, etc.)
on ►oPSAtI. �n�r�D in Kf��nnP�fE�'tL� , N.C.
(Waterbody) (City/Town and/or County)
The a plicant has described to me, as shown below, the development proposed at the above loca
'0 I have no objection to this proposal.
I have objections to this proposal,
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawini
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set b,
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to v
the set ack, 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 erty O er I fo a ' n)
Signature
1y I t> �,J fi�u aN
Print or Type Name
alS po5 w 804 LyJ
(Adja t ro rty OwnCer- Information)
Pr110r Type Name
C� t

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i��! � 12C8ECC'+ W 4TS6,.-) I
(Name of Property Owner)
property located at 3Z s -Dog" o u d L,--�
(Address, Lot, Block, Road, etc.)
on 1i�S�,`l S�J�d , in 4J N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above loci
�_ I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawin
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set b
minimum distance of 15' from my area of riparian access unless waived by me. (If you wish to
the setback, you must initial the appropriate blank below.)
`''�'tb1 do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Pro erty Own Informa 'on)
Signature
1�.pv1D �., PTSa�
Print or Type Name
32 '�- Z�o,,- WnJ L -J
(Adjacent Property-fter nformation)
Signature ` r . _
141.4s4ruk-/
Print or Type Name
321 Dfwoot0 GA/

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