66532D - Windchase

LIaI'CAMA / ❑ DREDGE & FILL Kartial
NERAL PERMITle ❑ ❑/ul'Tlew Modification Complete Reissue Reis
P'
A
Previous permit #
Date previous permit issued
ized by the State of North Carolina, Department of Environment and Natural Resources
2f '
;oastal Resources
Commission in an area of environmental concern pursuant
to I SA NCAC /%
21Rules attached.
Zyn
��
Name
Project Location: County AZI
I'.!%I C'4r,5" zsN
Street Address/ State Road/ #(s)
%%
ZIP 2
//Lot
t 1C'G,.,
�i
r
3W E-Mail Kh'k am,
Subdivision
ad Agent
City WI V`tr'4dt )�P<-?
ZIP 7-;f
❑ Cw
Eil W }PTA ❑ ES ❑ PTS
Phone # (`��/') 2 541y A4
River Basin
❑ OEA
❑ HHF ❑ IH ❑ USA ❑ N/A
Adj. Wtr. BodZ911W
(nat 6
❑ PWS:
des % no
PNA yes / n61
Closest Maj. Wtr. Body
Project/ Activity
:k) length
tform(s)
Natform(s)
igth
fiber
/ Riprap length
distance offshc
c distance offsh
innel
is yards
Ildozing
Length > &&
not sure yes
im: n/a yes S
yes C.
[[ached: yes e
A
r%
(scale:rAJ
g permit may be required by:
ocal Planning jurisdiction)
�T /e ��7 111 s ❑ See note on back regarding River Basin

WC Division of Coastal Mgt. Habitat Impact Computer Sheet
PPlicant: j►nC �,1�5-�' . Permit #:
,/V r
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
'ound in your Habitat code sheet.
iabitat 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/o
temp impact
amount
r ,
V v
Dredge ❑ Fill ❑ Both ❑ Other
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 El Other ❑
Dredge ❑ Fill 171 Both 171 Other ❑

Pat McCrory
Govemor
NCDENR
North Carolina Department of Environment and I
N.C. Division of Coastal Managen
AGENT AUTHORIZATION FOR
Date: V tI m"ix J`)%'
Name of Property Owner Applying for Permit:
mol
Owner's Mailing Address �J
14J114Aei8', fit,. Z,q�t
Email: /,,�4'7'L 4.- rv� ,�'Y, it"'m
(,li~
Phone ) i/ S `1)
Ir& CfA G'ir"&Vt
P.O.kxMB
Wm� WoMN;2W
�l -(0P 'Am 3/ bwt
(�VE
R�
APR 15 2016
C
Name of Authorized Agent for this project:
rr L�r,
Agent's Mailing Address:
:.M
W
Phone
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for, obtaining all CAMA Permits necessary to install or construct the following (activity):
For my property located at ,_�It) i✓J r vrI'asL /gw? ; dlt:w; I.1h, N)c. , 2-5'1/Gi
This certification is valid 1 year from (date)
Vaip'412Y ;4_

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: c5 7 ,�'��
Address of Property:
(Lot or Street #, Street 6r Road,
Agent's Name #:
Agent's phone #:
Mailing Address:
Y
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 descritAw or drawky, with dimensio must be orovided with this letter.
I haye 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
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection /f you have been notified by Certified Mail.
WAIVER SECTION 1�
I understand that a pier, dock, mooring pilings, breakwater, boa ouse, 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.
(Property Owner letformation)
Signature
Print or Type Name
(Adjac9ppit Prop OvAngr Information)
Signature
Sft�Ir.2�
Print or Type Name
Mailing Address
Mailing Address

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: 45� 4,'l 6
Address of Property. T
(Lot or Street #, Street 6r Road, C
Agent's Name #: 4- Mailing
�Address:
Agent's phone #: �/ zi' r� J�? .� JJ' G��- ;�"t „�j� �%� %JI
V
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 deeoriEatlim or *syba vrth (brew-Ni ms awed be erovided with this Wetter.
—ZI �h(aye 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
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drtve Ext.,
Wilmington, NC, 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objecdon if you have been notified by Certified Mail.
WAIVER SECTION ��
I understand that a pier, dock, mooring pilings, breakwater, boa Ouse, 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.
(Property Owner (ti#ormation) (Adjacent Property Owner Information)
Signature Si)ature
Print or Type Name Print or Type Name
MaNing Address Marling Address

t & TA
N11",
A..
>
log
J)
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rn
;0 Existing
> Ramp EyisUng
P, --Floating Dock
F'xro Pier..
Proposed 6'>., 8
Fix" Leo-_
U
SI
3 t4
Ov
ETBACK
TO r
0 C
EL
5L Sep
GRAPHIC SCAM Existing
Flo-itirp Dock
I unit m IL
ONE QUA P\f-ER OF
VIATERI=�nn\-,