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36ENERAL PERMIT Previous permit # A
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:oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: � Q,►� L-a h -' _
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
l�trr��lSJrr//r ! Jec'c
i
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: CA
at my property located at
in J jp'o 96,ovtl-County.
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:
Signature
Print or Type Name
(� W "A')
Title

NC Division of Coastal Mgt. Habitat Impact Comi
Applicant:
Date: („ WABTITAIT
Describe below t 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
Fill
(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
res
restoration or
and/or temp
restoration or
ten
temp impacts)
impact amount
temp impacts
m a
V t/
Dredge [IFill Both El Other [I�!/V
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ 0ther ❑

1FY THAT TH15 PROPERTY WAS SURVEYED AND MAP DRAWN UNDER MY 5UPERV1510N: n^i
THE FACE OF THI5 PLAT; RATIO OF PPEC1510N A5 CALCULATED BY COMPUTER
JNDARIE5 NOT SURVEYED ARE SHOWN BY BROKEN LINES PLOTTED FROM
HAT THI5 PLAT WA5 PREPARED IN ACCORDANCE WITH "THE 5TANDARD5 OF
NG IN NORTH CAROUNN (21 NCAC 5G, I G04); WITNE55 MY ORIGINAL SIGNATURE,
kL THI5 22ND DAY OF 5EPTEMBER A.D. 2015.
FOCAL POINT A5 PER
• MB 37, PG 3G I
FLOOD EBB -a-
5U N5ET LAGOON
NHW LINE TABLE
LINE
LENGTH
BEARING
LI
39.13
580021'00"W
L2
5.90
58000714"W
L3
14.98
575035'S0"W
17 �:9 SI TE � s�
74
J / wst
LOCATION MAP
NOT TO SCALE
SURVEY REFERENCE
MAP BOOK 5 PAGE 127
MAP BOOK 37 PAGE 3G I
DEED BOOK 5897 PAGE 279G
NOTE: THI5 LOT 15 LOCATED
IN ZONE AE (EL. 14) A5 PER
MAP # 37203 1 G700 J
COMMUNITY ID # 3753G I
DATED: APRIL 3, 2000
CORRIDOR LINES PER _ / FLOATING DOCK RIGHT
RECORDED MAP / AT PIERHEAD LINE
.HEAD LINE ----------------�-----IE-------�
L FLOATING,'
a'' `7 DOCK;. /
PRESUMED CORRIDOR LINES
& (u� / RAMP 15, I' I (NOT 5HOWN ON RECORDED MAP)
.wive�� RAMP '/���>, �� i
�Svr i�a 6C��
PIER
DRMAL HIGH WATER 15
FACE OF BULKHEAD
i
(D
(�yy c/ GAZEBO
><i5�1�� PIS
lco — III
15.01
I z0 5
,u c -0
THI5 MAP AND FIELD 5URVEY WERE MADE
FOR THE EXCW5IVE USE OF THE PERSON,
PER5ON5, OR ENTITY NAMED IN THE
CERTIFICATION HEREON. SAID CERTIFICATION
DOE5 NOT EXTEND OR TRAN5FER TO ANY
UNNAMED PER50N, PER5ON5, (- =NTITY
WITHOUT AN EXPRE55ED RE-CERI1"CATION
BY THE 5URVEYOR NAMING SAID PERSON,
PER5ON5, OR ENTITY.