69029D - Lanier

NC Division of G®at�gal .M9t. WORM impact CoMpaistae' SheOt
plicant:
scribe below the HABITAT disturbances for the application.
values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. _Ft.
for.
FINAL Sq. Ft,
(Anticipated final
TOTAL Feet
(Applied for.
FINAL Feet
(Anticipated fins
DISTURB TYPE
(Applied
Disturbance.total
includes any
disturbance.
Excludes any
Disturbance
total includes .
disturbance.
Excludes any
abitat Name
Choose One
anticipated
restoration
any anticipated
or
restoration and/
temp impact "
restoration or
ternimpacts
and/or temp
Impact amount
restoration
tem im acts
amount
D (�
Dredge ❑ Fill ❑ Both ❑ Other
c
l �p
Dredge ❑ Fill ❑ Both . ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ ` Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge. M. Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

Comments
3/17/2017
Allied Marine
Contractors LLC
DC Lanier for First
Lanier's Citizens
Campground Bank
5419 $200.00 GP 69029D

� A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date � as
;dame of Property Owner Applying for Permit:
LL C
Mailing Address:
S
I certify that I have authorized (agent) Gar
�"ram (�'%f to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary tn
install or construct (activity)
at (my property located at)
This certification is valid thru (date)

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w"Jiti)d 43 X °�
08jx�
rm7DV)`�-, /,
�o�bdti7� S,la,vb�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to is
(Name of Property Owner)
property located at L �,a O yam✓ 7" c o ����� 5 rrt� ��
(Lot, Block, Road, etc.)
on /<5 in
(Waterbody)
Applicant's phone #:
jr u 2 F e -T7�, , N.C.
(Town and/or County)
Mailing Address:
2 L `i cD
Cc . /--,
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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.)
M w 41 G I do not wish to waive
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-------------------------------------------------------------------------------------------------------------------
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
Mailing Address Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSIBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 1,4119Rs eA►yQ9,Pov91 is
(Name of Property Owner)
property located at CAM F� ► +-AT- .Dk / p y ,
(Lot, Block, Road, etc.)
on s &-ek in ,�o�y��� , N.C.
( aterbody) (Town and/or County)
Applicant's phone #: 91kko 0`071)0 Mailing Address:
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
-------------------------------------------------------------------------------------------------------------------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Z G-14
Mailing Address
(Riparian Property Owner Information)
Signature