68092D - Stewart

': CAMA / '❑ DREDGE & FILL #3 , ,1 �' A B
MNERAL 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 15A NCAC ©-1 H I i-o )
-1--) ❑ Rul_eiattached.
t Name�Fi Ll Nl Project Location: County-(i�lCLt/�..
Z—j'TT�E (2�j C� Street Address/ State Road/ Lot #(s)
JQQ12-QQ l'% State --zl P 7 771)'J '::�6- 2-L­ F> N S C)l t' �
(► I r )� �6 - G �66 E-Mail Subdivision (� Q
ad Agent � ,JIM 9 /VoA-74 City )(��1,CuX ��u zip 7 9-44
❑ CW )CW `WTA ❑ ES ❑ PTS Phone # ( ")" River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A f/A �5
J.".,
❑ PWS:
yes /.- rr6 o PNA yes n
Project/ Activity
length
igth
nber
I/ Riprap length
distance offshore
u distance offshore
annel
Pic yards
ip
s oatl' � 3
illdozi
Length 0
not sure yes 60
iurn: n/a yes Cho
yes o
lttached: no
Adl. Mr. Body
1N6L�
Closest Maj. Wtr. Body JL6PSAi t-
�cat>�lp
(Scale:
'Y
ig permit may be required by: l��jU�� j ❑ See note on back regarding River Basin r
nral Plannina IPPricArtinn)

NC DIVIS On Of 4-,O tWLcai .,x�;��• emu�da�s YY9PRO Mry � _ r
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.
S Ft FINAL Sq Ft. TOTAL Fe,
TOTAL q.
(Applfod for.
(Anticipated final
(Applied for.
(AM
DISTURB TYPE
Disturbance.total
includes any'
disturbance.
Excludes any
Disturbance
total includes.
Asti
Exc
Habitat Name
Choose One
anticipated
restoration
any anticipated
rest
restoration or
terrip im • acts
and/or temp
Im act amount
restoration or
tern10 acts)
tem
am(
Dredge ❑ Fill ❑ Both ❑ Other
Dredge ❑ Fill ❑ ' Both. ❑ Other ❑
Dredge ❑ Fill El.: Both .❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑. Both ❑ Other ❑
Dredge. ❑. Fill ❑ . Both ❑ Other ❑
l1_;
Dredge ❑ FIII ❑ Both ❑- Other El

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Comments
3/8/2017
Jimmy
North/Coastal Wells
Marine Piers Jeff & Linda Fargo
Bulkheads Stewart Bank 21 - - -
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property y Owner Requesting Permit -
Mailing
J�
Address W.-I
IV
Phone Number:
Email Address: 1 r° TT s�W���� @rn rf✓•
I certify that I have authorized ,^.n M �o ,
gent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: A <Ny / //_177Z�
at my property located at
in i' C `�7 � County.
�ile`fe h 1_41� , f-ra! /
I furthermore certify that I 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:
ignature
Print or Type Name
IN -A &'_x7 '::�_
le
a: l\q I\"\

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to / ti /"c f . J 's
of—perty Ow r) "
property located at e�� • /ice► dPo'S� rr ( sq; / /V e
(Address, Lot, Block Road, a c.)
on in h d f-
(Waterbody) (City/Town and/or Count )
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)
J C C Q Ma 10/
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.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
s L ; ura' % ,
(Adjacept,Propgrty Owner Information)
ry G
Print or Tym Naine
Mailinn drHmee
n/t or ype Na e
M-nilinn dr"r oo i i

ADJACENT RIPARIAN PROPERTY (OWNER STATEMENT
I hereby certify that I own property adjacent to L; H �- �f� l 's
!� /y - �n �"� ►' Su rr (Name of Property Own r)
property located at GS /v�. G, a Ale—
/ J (Address, Lot, Bloc Ro d, et .)
on,r�Sal ( Sal �r in �e/, , N.C.
(Waterbody) (City/Town and/or Coun )
The applicant has described to me, as shown below, the development proposed at the above
loca io .
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.
I do not wish to waive the 15' setback requirement.
Owner Information)
~(r—
M;��
er Information)
Signature
Print or Type Nap�nne k�g Z L F'R D� D��✓G S 1-2
9`3V e lL&1 "� r reek C rc/e
Mailinn ArIrlro z z
Print or Ty?,pg, NNa,��0 /
Y �pnra)'Q �l Canes
Mailinn Arlrirwcs /_

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