69308D - Howell

4CAMA / l !DREDGE & FILL `0 Ib
�NERAL PERMIT Previous permit # A B
New ❑Modification El Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources /
Coastal Resources Commi ion in an area f environmental concern pursuant to 15A NCAC '071- . 1%60 f
❑ Rls attached.
nt Name t Project Location: County (1 f k)
sF Street Address/ State Road/ Lot #(s)
%L/y1t State ZIPS 77rr310
#)79T-_76sz E-Mail // Subdivision
ized Agent f 4 �i I^ �> /Q%i'}-- City ` "'C/•� ZIP
❑ CVN N?fW C +TA AS ❑.PTS Phone # ( "—) % _ A River Basin
❑ OEA HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body4C/ O n
❑ PWS:
yes no PNA yes / nd) Closest Maj. Wtr. Body '-2
of Project/ Activity 5A111
(Scale:
ock) length
i
'latform(s)
g Platform(s)
ength
umber
ad iprap length
vg distance offshore
iax distance offshore
-hannel
imp
ruse/
Bulldozi
ne Length ? 3
not sure yes n
)rium: n/a yes pa
yes 49
Attached: es ,-no.-
Ping permit may be required by: ZA
❑ See note on back regarding River Basin

Pilings and More
910-3272009 p.1
V37#
X
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
r arne of Property Owner
property located at
(Address, Lois, Block, Road, etc.)
on , in . N-C.
(Waterbody) (City/Town and/or County)
has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal. --
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
dnridual proposing development must Fill in description below or attach a site drawing)
J
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 roust 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 Informatla
Sivnazure
�1� l%R,'Pi Ate"
Prin�orT�YPeiNJ�e ,� �n n i�
(Adjacent Property Ow, er Information)
Stature"
zS
Print or Type Name
iFiling Address/
Mfrng Address We &1G06
n.L� ra

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: (_ /Q f La 11 p0 i'L. e�
Mailing Address:
Phone Number: 72
Email Address: l' / !/r - -«- h '00 �M
I certify that 1 have authorized LTv% 71 s i v Al3Y A111 . Al D
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
in Z-2.1te�11n' Co- ,
I furthermore certify that I 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:
�. .m/wAmEN
Signaturd-
.�� .��i,� ♦I'//♦ ice../ �Title
011
ate

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at
I
(Address, Lot, Block, Road, etc.)
on , in , N.C.
(Waterbody) (City/Town and/or County)
has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
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. /
A&A I do not wish to waive the 15' setback requirement.
(Property Owner Information)-) (Adjacent Property Ow er Information)
Si ature Signature*
f -57 W-e'o't241
Pn'nl or ype me Print or Type Name
$'OD 6 /I Lwc 4si X&
)IAOillnn d rlrnnn AA..:I;--

yD'r" 2;
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that {own property adjacent to )-�Z-J- N Z��� 's,Name of Property Owner}
it i'Z Vail, C' i� ryQ
property located at
on
(Waterbody)
(Address, Lot, Block, Road, 6tc.)
in
(City/Town andior County)
N.C.
'b d to me as shown below, the development proposed at the above
The applicant has descn e
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)
i
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.
� V
I do not wish to waive the 15' setback requirement.
2ProepelOwn Informs 'on) (Adjacent Property owner --Information)
SI attire Sio igkire*
Print or T pe Name Print or Type Nam
y /�5�15'*�U�ecta e
on ZM Unilinrr Adrl _S Mailirl�Addre�ss 1 i

NC Division of Coastal
Applicant: C I e—, 1(�e
Mgt. Habitat Impact Computer Sheet
Date: /a • 3 .
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)
Dredge ❑ Fill ❑ Both ❑ Other
L�
Dredge ❑ Fill [`] Both Other 0
[�C/
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other 0