68072D - Owens

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(Name)
Comments
3/2/2017
Will
Bill & Bonnie
BB&T
6639
S200.00
GP 68072D
SF rct. 3779I
Richardson
I Owens

,NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: g [ t ( 2 bjVl(/1 r 0V•-P,5
Date: 0��6 L %OI
Permit #:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
found in your Habitat code sheet.
Habitat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp
impact amount)
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp im acts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
1
Dredge ❑ Fill ❑ Both ❑ Other 0
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ .Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑ .
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both Q Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

�Y
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
:dy Eaves Perdue James H. Gregson
error Director
AGENT AUTHORIZATION FORM
Date: 2-20-2017
of Property Owner Applying for Permit:
Bill & Bonnie Owens
:rs Mailing Address:
782 Windy Point Road SW
Supply, NC 28462
Dee Freem
Secret;
Name of Authorized Agent for this project:
Will Richardson
Agent's Mailing Address:
3235 Seacrest Ave. SW
Supply NC 28462
s Number( 91)0-297-0821 Phone Number( 910) 367-0335
y that I have authorized the agent listed above to act on my behalf, for the purpose of applying
J obtaining all CAMA Permits necessary to install or construct the following (activity):
Private Docking Facility
operty located) at 1907 Sea Aire Canal Supply, NC 28462
?rtification is valid thru (date)
4 415 �� CR, 1, " 1 Q, � i/, 4, a-
5-31-17
LL
1

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A P1 FRQYIOORflVG Pff"GSIBOATLIFT/B OAT$O USE)
I hereby certify that I own property adjacent to
property located at
on Canal
(Waterbody)
Bill & Bonnie Owens is
(Name of Property Owner)
1907 West Sea Aire Canal
.(Lot, Block, Road, etc.)
Applicant's phone #: [phone]
in Supply
(Town andlor County)
Mailing Address: 3782 Windy Point Rd
Supply, NC 28462
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 I boatlift I boathouse
must be set back a minimum distance of fifteen feet (15� from my area of riparian access�untess
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 he filled in by individual proposing development)
Private Docking Facility
Please see attached drawing
Will Richardson (Ruth. Agent)
(Information for Property Owner Applying
for Permit)
3235 Seacrest Ave SW
Mailing Address
"& C
(Riparian Property Omer Information)
Signature
Supply, NC 28462
City/State/Zip
William H. Bland
Print or Type Name

ADJACENT RIPARWK PROPERTY OWNER STATEMENT
(FORA PMWO0RIWG I'ILINGSIBOAT'LYMBOAT ffOUSE)
I hereby certify thatI ownp=opertY Ascent to (a & Bonnie Owens
ame of Property Otvner)
property located at 1907 West Sea Aire Canal
.(Lot, Block, Road, etc.)
on Canal 3 in
(Waterhody) _ — --
Applicant's phone #. [phone]
Supply
(Town andlor County)
Is
Mailfaig Address_ 3782 Windy Point Rd
Supply, NC 28462
N.C.
ent he is proposing at that location, and, I
He has described to me, as shown. below, the developm ilia I boatlift I boathouse
have no objections to his proposal. I understand 'hat a piedmooringu; of riparian acres untess
must
be set back a minimum distance of Been feet (15') from my P
waived by me. (if You wish to waive the setback, you must initial the appxopriste blank
below,)
I do not wshto waive
I do wish to waive that setback requirement.
DESCRIPTION Art-D/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be frlted in by fndfvidual proposing development}
New Private Docking Facility
Will Richardson (Ruth. Agent)
('information for property Owner Applying
for Permit)
3235 Seacrest Ave. SW
Maiing Address
t�t�c�Ylii�'
(Pdparian properly Omer Information)
k
•/ ignature
Supply, NC 28462
C'rtylState/Zip
Gregory Thomas Gray
Print or Type Name

10k Boat Lift
Canal