69134D - Myers

CAMA / ❑ DREDGE & FILL
iENERAL PERMIT Previous permit #
New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued_
ized by the State of North Carolina, Department of Environment and Natural Resources
oastal Resources Commission in an area of environmental concern pursuant to 1 SA NCAC LoLi Rules attached.
Name
N'4
JJV f- State zip 83�1
(qa) ' y E-Mail
ed Agent i� RlanW
❑ CW XEW )(PTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
Project Location: County S"J ;('V-
Street Address/ State Road/ Lot #(s)
i i U(o E . YA('�4 'b.-.
Subdivision
City )ak �sla� zIP ZSW�`_
Phone # O River Basin C.
Adj. Wtr. Body��� (nat �f
Closest Maj. Wtr. Body 4T iJ
PNA ye / no
Project/ Activity Con
(Scale: I
ck) length (o' X 1 3(o,
atform(s)N>I4- 5�
Platform(s) 9)rIL
�ngth
amber
Ld/ RipAoffshore
g distaax dist
hannel
ibic yards
_V
mp
use/ Boatlift 13" Y 13,
Bulldozing
ne Length soV
not sure yes
3rium: n/a yes
yes { no)
r Attached: yes no
ding permit may be required by: �w n 6 n
❑ See note on back regarding River Basin

neceiveu
I lie ositea
I trName)noiaer
ivumner
amount
I Uomments
5/4/2017
Allied Marine
Phillip Myers
First
5554
$200.00
GP 69134D
Contractors LLC
Citizens
Bank

NC Division of Coastal Mgt. Habitat Impact Com
Applicant: Pk' (�' m `��'`rS # Gq 13 q
Date: 051&gI :7-
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.
(A
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di:
Habitat Name
Choose One
includes any
Excludes any
total includes
Ea
anticipated
restoration
any anticipated
re:
restoration or
and/or temp
restoration or
tei
tem impacts
impact amount
temp impacts)
ar
/�
L, ► V \
Dredge ❑ Fill ❑ Both ❑ Other z/
L400
q 80
U'�
Dredge ❑ Fill ❑ Both ❑ Other v
3�,
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:
Mailing Address:
6
Phone Number: 0I�_ggLj y 2
Email Address:
I certify that I have authorized +M"e) A)/'�
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:©E{�l
t
at my property located at
n
in /� 1,4 r� j's -: C County.
4)-
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission t
Division of Coastal Management staff, the Local Permit Officer and their agents to ent(
on the aforementioned lands in connection with evaluating information related to thi
permit application.
Prope Owner Information:
f �
Signatu
l
rint or T e Name
'/7k%vo—�
Title

CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PPAOPERTY OWNER NOTIFICATION/WAIVER FORM
game of Property Owner:
kddress of Property:
or Street #, Street or Ro , City & County)
kgent's Name #: /�'�J / �tW�r+`. Mailing Address: q -') #"*'c. / G�
agent's phone #: /�' 2 � �`� �, ) Y°/k,�.S4d 4
hereby certify that I own property adjacent to the above referenced property. The in ivi ua
kpplying for this permit has described to me as shown on the attached drawing the development
hey are proposing. A description or drawing with dimensions. must be provided with this letter.
I have no objections to this proposal. —ZI have objections to this proposal.
fyou have objections to what is being proposed, you must notify the Division of Coastal Management
DCM) in writing within 90 days of receipt of this notice. Contact information for DCM offices is
available at http •!/www. nccoastalmanagement. netlweb/cm/staff-listin g or by calving ?-888-4RCOAST.
Yo response is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift must
:>e set back a minimum distance of 15from my area of riparian access unless waived by me. (If
lou wish tpwaive 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.
;Prop Ow Information)
signature
rvo
print or pe Varne
l y4y ��h w 5�
(Riparian Prope Owner Information)
f
k2� UV�
Sig at r
G
Print or ype Name 173 Cry aZ 4t,

3/.V—,n 17
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Address of Property:
)c!) 11D fd.' ` r I
(10—t or Street *, Street or
,�} City & County)
Agent's Name *: l �iz� 1 j/ t r A, Mailing Address:
Agent's phone #: �/�) �' 5 3� rrl,00r,7�/yc, RA —
hereby certify a own property adjacent o the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing the development
descriptionthey are proposing. description or drawing. with dimensions lust be provided with this letter.
XL
7 proposing.
1 have no objections to this proposal. I have objections to this proposal.
le
If you have objections to what is being proposed, you must notify the Division of Coastal Management
(DCM) In writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at http //www nccoastaJmanapement.nettweb1cm/staff-listing or by calling 1-888-4RCOAST.
No response is considered the same as no objection ff you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Signature
-1 it .A
(Riparian Property Owner information)
Signature

fol l�zr ,� ,D�
/rl.,;.nAnt
9560 94090319 5155 0609 45
AurWW N umber (Transfer from service label)
7015
0640 0007 s417 w ■
1piliq
• 4 •v 1 F fli `f
mpiete ftWnta 1, 2, and 3.
it your name and address on the reverse
that we can return the card to you.
ach this card to the back of the mailpiece,
an the front if space permits.
cle Addressed to:
jep,
I
3. Service 'Type
o c s+ P *kftd oeftye+y
QMM.d M•+�
0 Co~ man PmUlMd Delivery
Cl Collect on DoWery
0 Coiled on Dovery Reshicted DeIN"
. 'id Mali
id Mali Restricted Delivery
Domestic Ret!'.
A. Si
f
X —aAgeo
r ❑ Addi
B. R e4 by (P ) C. Date of Di
D. Is delivery address different from Item 1 ? ❑ Yes
If YES, enter delivery address blow: ❑ No
113 Glut WC,

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