68559D - Flack

.CAMA / DREDGE & FILL jl ."i j
"ENERAL PERMIT Previous Pe mit#9 A B
New -Modification —]Complete Reissue Partial Reissue Date previous permit issued
rized 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 0:� �(. 7 on
�.�I j� h
t Name �( r('tnE �Q
')-Na ►4f, State ZIP 30 32f3
` (� 20 2-- 21,11 E-Mail
:ed Agent
XI CW )(EW PTA S ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
yes G PNA yes
f Project/ Activity
ngth
mber
d/ Riprap length_
distance offshore
x distance offshore
cannel
sic yards_
np
se/ Boatlift
e Length " 50
notsure yes
% ❑Rules attac ed.
Project Location: County ;_Cs
Street Address/ State Road/ jLot #(s)
Subdivision
City 004 K (d $'C4 ZIP
Phone # ( ) r River Basin <:�F
Adj. Wtr. Body Ana
Closest Maj. Wtr. Body
■■■■■■■■■■■■■■■■��■■■■�1
ium: n/a yes no 0
yes no
kttached: (9 no
ng permit maybe required by: DoY— ­7 7�
(Scale: j' ; 1
❑ See note on back regarding River Basin n
� I i
Local Planning lurisdiction)

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
MailingName of Property Owner Requesting Permit:
Address:
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at j:;�,L
in 820?2�2,4116,kfcounty.
I furthermore certify that 1 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:
Signatu
ird
Print or Type' Name
o 6) L4
Title

1, 2, and I
and address on the reverse
turn the card to you.
to the back of the maiipiece,
space permits.
§`COO- PLETE;.THIS SECTION ON DELIVERY ,r
A. Signature
■ Agent
��
B. Received by (PrintedName) «: " - • r
D. Is delivery address different from item 1 ? ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
❑ Priority Mail Express®
❑ Adult Signature
❑ Registered MaIITM
❑ Adult Signature Restricted Delivery
❑ Certified WHO
❑ Registered Mail Restricted
Delivery
3 0319 5155 0469 67
❑ Certified Mail Restricted Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
icfar from cAniino lahall
❑ Collect on Delivery Restricted Delivery ❑ Signature ConfirmationTM
0001 6769 5 51,1
;ured Mail
cured Mail Restricted Delivery
❑signature Confirmation
Restricted Delivery
er $500)
it 2015 PSN 7530-02-000-9053
Domestic Retum Receipt

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Property Owner.
Address of Property: �1`S CJ —' rY • V---t// C&11 /-1>
p
(Lot or Street #, Street or Road, City & County)
Agent's Name #: ' // �{ / /�✓�� Mailing Address:
Agent's phone #: l �U ' a� ` ,��5 , 1
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
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 if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15from 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 operty Owner Information)
2� , � G
gnature
/f �O 119eri1)6, A .
Print or Type Name
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailinn Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ��-L-(Q 's
property located at �(j �/ / , / bC v,-y (Name of Property Owner)
(Address Lo Blocl� k ��Rod tc.)
on c� in �0 (L�A.= N.C.
(Water y) (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, 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
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) (Ad c nt Pr a wnnoi�)nfor ation)
Si azure Signa re 6Qt1m,- Sari
J- lk4ni Lewis 01d ua
Print or Type Name l Print or Type �N me ��
n i r► I I- I- h ��I/ t rr ti h

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent tot. 1 �� s
i-4�)
ame of Property Owner)
property located at � • -
(Address, Lo B! k, Ro d, n .)
on in b /L 't��2�1 , N.C.
LZU(Wa y) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above location.
> v I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 petback, you must initial the appropriate blank below.)
AtQ-/I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacen Property wner Information)
S' toe / S' nature
Qfr La 1A/
Print or T�ypi:e�
N e
.".. i �:1

Existing dock with 8' x 16' attachment
for 16'x 16' new floating dock
Existing ramp
`Existing pier
15-

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant:LIA4k Vi .? q
Date: 1 (� It
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
FINAL Feet
(Applied for.
(Anticipated final
(Applied for.
(Anticipated final
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
disturbance.
Habitat Name
Choose One
includes any
anticipated
Excludes any
restoration
total includes
any anticipated
Excludes any
restoration and/or
restoration or
and/or temp
restoration or
temp impact
temp impacts)
impact amount)
temp impacts
amount)
L `' \
Dredge ❑ Fill ❑ Both ❑ Other (
ii
2-
0 L-.
Dredge ❑ Fill ❑ Both ❑ Other rtf
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0