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CAROLI NA BLUEWATER CONSTRUCTION
Custom Beach, Mainland, and Golf COuI"Se Homes
Complete Design / Engineering / Building
6934-9 Beach Dr. SW, Ocean Isle Beach, North Carolina 28469 [phone]
, 10'-6" 16'-0" 13'-6" 10'-0" .
o a 16' x 8' 1 13' x 13'
6 o Alum. Dock I Boat Lift
w/ 10" Piles
q 4'x16'—_—�
N Alum. Ramp
Grass -Line
20 S20°00'00"E 49.98'
3
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48' Vinyl Fence
'arcel #: 243MD038
Iwner. Gregory & Danna Whitman
14370 Blackfarrns Road
Huntersville, NC 28078
LOT 105
5,748 SF
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Parcel #: 243MD036
Owner. Peggy Mast
8550 Deepwood Dr
Henderson, NC 27536

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ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIE"OORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent toy
s
(Name of Property Owner)
property located at
on
(Waterbody)
Sr
(Lot, Block, Road etc.)
L1in 1 , N.C.
(Town and/or County)
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.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT;
(To be filled in by individual proposing development)
(Applicant Information)
MculingAddress
(Riparian Property Owner Information)
Signature

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: 55 3 p
Phone Number:
Email Address:
I certify that I have authorized
aqIIVICA
a- © L -G o ti—r
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: IlfI) Vf 5id °y,4o j
DOCK
at my property located at 2S Y R0 h Ib e,
in '-bVllVG\MCL County.
l furthermore certify that l 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
t,J rno 5'S
Print or Type Name
Title

NC Division of Coastal Mgt. Habitat Impact Comp
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 Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FIh
(Applied for.
(Anticipated final
(Applied for.
(An
DISTURB TYPE
Disturbance total
includes any
disturbance.
Excludes any
Disturbance
total includes
dist
Exc
Habitat Name
Choose One
anticipated
restoration
any anticipated
res'
restoration or
and/or temp
restoration or
tern
temp impacts)
impact amount)
temp impacts
am
Dredge ❑ Fill ❑ Both ❑ Other
ZA�
Z
Dredge ❑ Fill ❑ Both ❑ Other`
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑