68088D - Kelly

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Comments
3/7/2017
Daniel Shirley,
Overbeck Marine
James Kelly SunTrust 1252 $200.00 GP 68088D CS rc

�,��X�o� NC Division of Coastal Mgt. Habitat Impact Comb
Applicant: }
Date: 3h l T
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
FI?
(Applied for.
(Anticipated final
(Applied for.
(Ar
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dis
Habitat Name
Choose One
includes any
Excludes any
total includes
Ex(
anticipated
restoration
any anticipated
res
restoration or
and/or temp
restoration or
ten
ternimpacts)
impact amount)
ternimpacts)
am
QDredge
❑ Fill El Both El Other
�� L
�redge Fi ❑ Both ❑ er
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 3Am&.4 A. KcLo'j
Mailing Address: 110. o)( c3 y o
Phone Number: 5 is 1q- 3
Email Address:
A Anr 1 c L. -LC-'7
I certify that I have authorized 0yLfl'i3Ec°xc /Lr2 iNcT ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: BV4L".�, -F77,),G�- t\ f) . t-0�-
at my property located at 1'1S �rlh;,�,�oc �;l\ L�rl� \AAM"SCtaQ Lit, ZS�fo9 ,
in fps 9A&oJE'A- County.
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:
JaAA VJ
Si a ure
Print or Type Name
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
iarle?5 a t5'q iI '( a 0
I hereby certify that I own property adjacent to Is
'' 11 j (Name of Property Owner)
property located at 1 7s" �►�lr Ddd /rt>,l I
// (Address, Lot, Block, Road, etc.
on GiSB/1lJd/D in f' N.C.
(Waterbody) (City/To n and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lQC2tion
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
e. f you wish to waive the setback, you must initial the appropriate blank below.)
j I do wish to waive the 15' setback requirement.
JI do not wish to waive the 15' setback requirement.
(Property Owner Information)
(Adjacent Property Owner Information)
S �ture
Pint or Type Name
Si nature
c -- l�atl V�(cs
Print 6r Type Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT J
I hereby certify that I own property adjacent to �i ��.�/ l L05Tg/P Or /�
s
I) , (Name of Property Owner)
property located at
/
nn / ' (Address, Lot, ock, Ro d, etc.)
on f/Y IQSO/l tY/d in iI !M6A Q N.C.
(Waterbody) (Ci /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.)
_NIP, I do wish to waive the 15' setback requirement.
� 1 do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sid at ire
A . kiul,
Print or Type Name
(Adjacent Property Owner Information)
Signature * ��
Print or Type Name

175 Whippoorwill Ln