69076D - Lawrence

kCAMA / DREDGE & FILL
3ENERAL PERMIT Previous permit # A B
New Modification LJComplete 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 (1 ( 1
M �'� f ina C a wr ❑Rules attached.
t Name
Project Location: County � jNl / ,
Street Address/ tate Road/ Lot #(s)
f ( 1[ WState ZIK 90 r Q r,(
(b)U16--5Z30 E(--Mail Subdivi 'on
ed Agent �� t" City ZIP Z-S-
❑ CW t �A ❑ ES ❑ PrS Phone #
� " ^�River Basin
❑ OVA ❑ HHF ❑ IH ❑ USA ❑ N/A Adj. Wtr. Body ^' __ Y • W (n
❑ a{�I
yes / no PNA yes no Closest Maj. Wtr. Body I bbLti; '5000 i-
' Project/ Activity
:k)length
itform(s)
Platform(s)
ier(s)
igth
�ber
i/ �tiprap length
dis�nce offshore
x distance offshore
Aannel
!Length T l UD
not sure yes {-D
um: n/a yes n
yes no
ttached: yes no,
M
(Scale: ( Q
g permit may be required by: �L�►" �'
.ocal Planning jurisdiction)
❑ See note on back regarding River Basin

NC DIVIS10111 Of COastal".Mgz' naumut ma.swax-
Applicant:
Date:
'
-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 Scl. Ft-
FINAL Sq. Ft.
TOTAL Feet,
for.
FIN
(A M
(Applied for.
Disturbance.total
(Anticipated final
disturbance.
(Applied
Disturbance
dish
DISTURB TYPE
Includes any
Habitat Name- Choose One anticipated
Excludes any
restorationany
total includes
anticipated
EXd
rest,
restoration or
temp Mpacts )
'
and/or temp
_IMpAd arliougt..
restoration or
temp i.ftipacts ).
tern]
a c
cLDredge [I Fill F1 Both 0 Other
)-
Dredger!
' Fill [I
Both 0
Other El
Dredge F1
9
Fill n.:
Both 0
- Other
Dredge E]
Fill [I
Both El
Other D
Dredge El
Fill El.
Both C1
Other ❑
Dredge. El.
Fill 0:
Both ❑
other El
Dredge E1
Fill 171
'Both Fl.
Other 171

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date � — 12 — 1 '�
Name of Property Owner Applying for Permit:
Martha Lawrence
Mailing Address:
114 Live Oak Dr.
Wrightsville Beach, NC 28480
I certify that I have authorized (agent) ' Trip Pippin" to act on my behalf, for the purpose of
applying for and obtaining all CAMA Permits necessary to install or construct (activity)
8x 16 Dock, at (my property located at) 667 Hickory Point Road
This certification is valid thru (date) _ `1 — I j — I �
L
Si
Date
Y

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Martha Lawrence's property located at "667
Hickory Point Road" on the Intra-Coastal Waterway, in Hampstead/Fender County N.C.
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 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.
J I do not wish to waive the 15' setback requirement.
(Props Ownr Owner Inf mation) (Adjacent Property Owner Information)
7
nure Signature*
r irl Wt I I am
Printr qr Type Name Print or Type Name
Mailing Addre�SS r Mailing Address

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to Martha Lawrence's property located at "667
Hickory Point Road" on the Intra-Coastal Waterway, in Hampstead/fender County N.C.
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 o` 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.
(Property Owner Information)
Lure i
Z �i/ r t? V1�`
Print Type Name
Mailing Addre
(Adjacent froperty Owner Information)
N
Print Ty e Namer
Maiflyg Ad�rB-
r r

I, Jason
l: [e-mail]
Thursday, May 18, 2017 10:46 AM
Dail, Jason
ect: Permit for 667 Hickory Pt
chments: 667HickoryPt.pdf; 667hickoryptAA.pdf; Hickory Point neighborCAMA_Batten_signec
Hickory Point neighborCAMA_Kenedy_signed.pdf
in,
are the forms for th dock at 667 Hickory Point in Hampstead. Could we pick up this pert
.riday? �1
I/ i
i ks,
i Pippin
An Marine Construction, LLC
-270-1290 - Office
-471-2034 - Cell
v.pippinmarine.com

lKar*a Lawrence
�' � tot