67192D - Frazier

�
?CAMA / ❑ tial
DREDGE & FILL V iE'11
� 7A / / i'� 6719',�' A B
GENERAL PERMI � = Previous permit#
New ❑Modification El Complete Reissue1 rReissue 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
❑ Wes attached.
t Name 1 �— Project Location: County �F.M
! 1 G (, Street Address/ State Road/ Lot( #(s)
1 StatJJ ZIP CiA Ul I7 l V
Mail Subdivision
ed Agent
❑ CW N4EW PTA )Us ❑
❑ OEA ❑ HHF ❑ IH ❑ USA ❑
❑ PWS:
yes J Ko PNA yes k no
Project/ Activity
:k)length
itform(s)
sic yards
e Length t SD
not sure yes
ium: n/a yes
yes
kttached: no
City LC c`/�� 1 F ZIP
Pho #r' River Basinyt h
Body CdnJ is n T & -41 (29a
Closest Maj. Wtr. Body n c' �`� 7 Vy
It.
ng permit may be required by: �y �SG` �£�G ❑ See note on back regarding River Basin n
Local Planning jurisdiction) �• _ / , ,

HG Division of G0a6t81-.Mqt. Heibitat Impact- col"putor Sheet
Applicant:
Date: (/
Describe below the HA 1 AT disturbances for the application.
All values should match the name,.and units of measurement found in. your Habitat code sheet.
Ft PIRIAI. Sq Ft TOTAL Feet F!I
..
TOTAL Sq.
(Applied for.
(Anticipated final
(Applied for.
(At
DISTURB TYPE
Disturbance.total
includes a.ny
disturbance.
Excludes any
Disturbance
total includes.
dis
Ex
Habitat Name
Choose One
anticipated
restoration
any anticipated
re:
restoration or
and/ortemp
restoration or
ter
temp impacts)
im act amount
temp im acts
arr
Dredge ❑ Fill ❑ Both ❑ Other
2
�
Dredge Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill Both ❑ Other ❑
0
l�
Dredge ❑ Fill [I Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. ❑. Fill ❑ . Both ❑ Other ❑
;:..
Dredge ❑ Fill ❑ Both ❑• Other El
ii

payment Proccessing Confirmation
Date Received 1/3/2017
;heck From (Name) Coastal Dredging LLC
Name of Permit Holder Rex Frazier
Vendor BB&T
Check Number 5141
Check amount $800.00
Multiple Permits No
Major/Minor
Permit Number/Comments GP 67192D
Receipt or Refund/Reallocated JD2498D

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date ) )-, j 5 1 I �
Name of Property Owner Applying for Permit:
f
Mailing Address:
2I7 AQWQ_,VC11 -lov,
Gwv,ICIC
I certify that I have authorized (agent) (5 \ to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
at (my property located at) ) q 0 Co cY--G0.V1 Z ( VJ
�T�> P s n d -R� e act t Mc �- ,;A 4S-
This certification is valid thru (date)
p rnr�ar}�� ■ ■VVnaM Cl"notnra nntP

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner: ' j C X H .
Address of Property: ) qo% Gears �61 VU D '1 13e-ck T)C g'
(Lot or Street #, Street or Road, City & ou/l2 1nty),p� �I�,
Applicant phone #: 90- 4 2� —'� (� 4 � Mailing Address: G /40 /1 /and D r
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 pro . g. A description or drawing, with dimensions, must be provided with this letter.
I have
are
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. Contact information for DCM offices is
available at www.nccoastalmangement.net/contact dcm.htm or by calling 1-888-4RCOAST. 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, or lift 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 s;71
ck, you must initial the appropriate blank below.)
do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
ReX T7 • � i�c��/ �
Print or Type Name
l2q �%a l �c,'fid 'DK -
Mailing Address
(Riparian Property Owner Information)
Signature
/J °y�
Print or Type Name
Mailing Address

r l.lt 111 !!_L) MAIL. KI I URN lit (:I. ll' f
I)IVISION OF COASTAL MANAGEMENT
ADAM I N I IIIPA141AN 1,140PIRTY OWNER NOTIFICATION/WAIVER FORM
Nomilill ►•IrriratlyOwltpt Iic. �� _�__!__ I, {` ►
nihlirran lit I�rr,irpNy {11' (? [ttl l e" I V<� �['�; �IL�_ 11 !� ,f
(I III 1rf titIPP.1 N, ' hrr±l or Head, CRY 1% fmillity) �Pr'1G1e r
illgJli put lllurr1 ff ��'� l `1 1 {� Mniling Addrrr.;!;
I holril+y I nrtlfy 111111 1 11wrt pillp rrty ar4acasnl to the above referenrod property. The individual
AlrlriyluU till Vila lrrtlridt haR dpsuribr3(I to mp ae shown on the ntteched drewing,the development
lliny aip fimili plop A des fltltion or dtbwitio, with di"I"Msio[ts, tTuet be drGYIS>1�� [•
LA I 1 luici ill, 11Iriet'liollm to IhiN 1'lr'lromirl I luive obJeclionu to this proposal.
If Vim rrovu utr)oufh/fis to what In baing proposed, you most notify the Division of Coastal Management
01 M) lit wrlflrrq withln 10 clays of ►9awpf of this notice. Contact information for DCM offices is
ovallAtrlM of www netr?nwal�hrrnrrgMrnsnf.nAUQonfaQf dcnr.htrn or by calling 1-888-4RCOAST. No
ra.frt►►t+a fll,fwnsiol�rnd /fr ss n ,as t10 ggj�ctlon nyou have been notifled by Certifled Mell.
WAIVER SECTION
I umlprnlalld that a plor, dock, fl'looflnu pilings, bronkweter, boathouse, or lift must be set back a
minlmum diulanvo of I13 from my area of riparian nc:cesls unless waived by me. (if you wish to
wialvo the $0imr k, voti MUlLLU lsll the appropHato blAnit below.)
L I rill wish to v4vp flip 1 G' setbAck requirement.
I do not wish to waive flip 1 fi nottiock rMqulresrncrnt.
(Ptollally Owner Itsfortnutlon) (Riper an Property Owner Information)
',i�•�i,N1ri � ,liknuhrrr
f'�nif ,i )41'a Nutria flint or TypA Nom9
A►•rtfiiill Idifit pit Mailing Adirlmse

4: Litl
mvINION OF COASTAL MANAGEMENT
An.IAc,rN1 141PA141AN pROPIRTY OWNER NOTIFICATION/WAIVER FORM
Noon's if I'lulia►ly t WiPt j o 11 ! i
At ItItrraa lit 111`011afty Ho l f
I 1rt rrt 1;I1nrl N, l:hon( of R(md, City & County) Pe ptl er G l�
Algdl� sill ldl,u�a Il �ir 1 ? i i(r �� r1 Mailing Addi-oss:
1 11wryhy r wtlty 11lot I llwll Irlohally nli)al:®nt to the ahnvo roterenced property. The individual
ulydyhlu till title prrtnlll hap dnpl:rihr!d In ma an plrown on tho attached drawing, the development
lliay qIp (gt.1t�lMlltg, �,�tl�l��iil.�it.dt!�wifll,�,_ �...����•
M 11111%;v Ilu (lhlruliolln it) Illih Moll sill 1 have objcclions to this propusul.
V/
If Viol# hav« Uh%aefh)rla to what le boing proposed, yuu ►roust notify the Division of coastal Management
In Wtlflny wlNflrr 10 dop of rwtelpt of Nlls notice. Contact Information for DCM offices Is
avallaillo at WWW�fIffQtlr►ashnanparn»nt.neVoonf�lc dcm.htm or by calling 1-888-4RCOASi. No
►a / dry tir ftfllnalrrt�frti gild lffnle ss Un QOMcNon If vow been notified by Certifled Mali.
WAIVED SECTION
I IIm11r:ipland that a plor, dock, monNnU 10109n, breakwater, boathouse, or lift must be set back a
mirilmum distance of 1 h' tram my area of riparian access unless waived by me. (If you wish to
walvo ilia sotbook, you MM&LIWW the appropriate blank below.)
1 (in wilih In wniva Iho. I5' netbnvk mquirement•
I do not wiph Ili wnivo tha Ili' notimck mquirament.
(P►ilipa ly Owner Information)
���
•,rr•u,rl,n,,
l�„�• 1 / l / lei
I •,�rri ��� !►I�n Nnrna
ll4nlhn,) 'Ir h lrr�a a
(Riparian Property O-lner Information)
,�iKnrrlurr� _,
Print or Type Nhrne
Afalling Address

U11I II 11LU MAIL RLi UIiN IlkC�1�'r a n�ERTED
DIVINION OF COAS TAI, MANAGEMENT
AIi IAt r NI 141PAl1lAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
+
Nwilrooil I'r►►i►a►ly()Wnal _
A+1+1+►+nn+,tI'I+,I,n+ly ►�� [l L.(1`!_ 3.� .._I.dI - /!1�-) ofll..N
it ++t ++t !;t►agi k, Street or Road, City & f `►+n+ty) pe/`lt`iek- G n
Aly,lir rill Irl►unr� It ��` rl f % %(� '� r>.__w_.. Meiling Address
I t+t3+r+l+y i ritilfy that I town priiparty adjacent to the above ref"roncod property. The Individual
til+lrlyl►+U (nt tlda f►anitlt i►ea to me Taro shown on the attachod drawing the development
that' p►►/t,►+►I,+,an+u f� d>�ttt;rltatictrl tar drhwinsi, Wlth c1itT�oti�(���,.m ti a t�?Y�... Imo. _��.��•
+►hiet'li► ll" Ill IItix lottqu►pul I h,+►► ++hjecti►►ttti to this proposal.
if yuet irev9 rrlilraflunt1t to whaf Is brrinp proposed, you ►nest notify the Divlslon of Coastal Management
(Dam) in wrlllnp withlh in days of rat»/pt of this notice. Contact information for DCM offices Is
avaNahla at www,h{illea+ta►ttlottgamont "obtonteot_dem.htm or by calling 1-888-IRCOAST. No
rarinu►.p y as�1! fetus 11-fle 0ON90Npn ffj ou have been notified by Certified Mail.
WAIVER SECTION
I in+ w,,llattii that a plot, dock, m000riny pllinpa, bronkwater, boathouse, or lift must be set beck a
tulnin+u►n tllatarti=ee or 16' (torn my at -an of tipwitin access unless waived by me. (If you wish to
wawa Iha aetbock, you MU&LIWU the appropriate blank below.)
P✓� I Ati wittft In waive Ilia i N i4elberk nmhuirriment.
I ciao not wiali to wnivo tho Vi mottinck roquiremeant,
(lirtyra)iy Owner hlfortnatlon)
��rr•,r,llttr �'
I'unf ,�t 1►la� Nnura
AinlNn+/ Fl,l+iraun
1 r/"` r') —
(Riparian Property Owner Information)
1r
Signature
Print or Type Name
Moiling Address

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