69346D - FAST

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant: P T �t'Oy,4,.v
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Date: C l -K ``2 C(7
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
FII
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Exi
anticipated
restoration
any anticipated
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restoration or
and/or temp
restoration or
ten
temp impacts)
im act amount)
temp impacts)
am
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Dredge ❑ Fill ❑ Both ❑ Other
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Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

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ANG-11AAA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date Aug. 25, 2017
Name of Property Owner Applying for Permit:
FAST Property / Steve Isabel
Mailing Address:
430 Montbrook Ln. Suite 207-208
Knoxville, TN 37919-2705
I certify that I have authorized (agent) Joel Klass to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary, to
install or construct (activity) pier, deck, and dock
at (my property located at) 539 Lockwood Folly Rd. SE Bolivia, NC
This certification is valid thru (date) $r- 3o " ? o 1-7

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to FAST Property / Steve Isabel s
(Name of Property Owner)
property located at 539 Lockwood Folly Rd
(Address, Lot, Block, Road, etc.)
on , in Bolivia N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
I an
7- 1 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 drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, 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 Information)
Signature
FAST Property / Steve Isabel
Print or Type Name
(Adjacent Property Owner Information)
Signature
Joseph B. Taylor ET Diane K.
Print or Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to FAST Property / Steve Isabel s
(Name of Property Owner)
property located at 539 Lockwood Folly Rd
(Address, Lot, Block, Road, etc.)
on , in Bolivia N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location;
' 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 drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, 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 I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
FAST Prosy / Steve Isabel
Print or Type Name
(Adjacent Property Owner Information
Ldy��
Signature *
Kim Ray Todd
Print or Type Name