68064D - Taylor

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�CAIVIA / CJ DREDGE & FILL
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3ENERAL PERMIT
K/ Previous permit#
New -Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources { 7 `,
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-oastal Resources Commission in an area of environmental concern
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pursuant to 15A NCAC (�� 1
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El Rules attached.
Project Location: County�f�%►��(n/i ( K
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❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
Adj. Wtr. Body L l/lG� gnat /
❑ PWS:
yes / /foj PNA yes /
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Closest Maj. Wtr. Body 'An 1 /Vvy
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(Scale: I
ig permit may be required by: CX lJ,S'c al ❑ See note on back regarding River Basin n
Local Planning Jurisdiction) ,, 1 1 p

NC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant: -' ,� VV-, o✓l 7a. j It.)
Date: D L/ 1.5 /Za , 7
Permit##: G '�v� q 4�
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
TOTAL Sq. Ft.
(Applied for.
DISTURB TYPE Disturbance total
Choose One includes any
anticipated
restoration or
temp impacts)
FINAL Sq. Ft.
(Anticipated final
disturbance.
Excludes any
restoration
and/or temp .
TOTAL Feet
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
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 ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge [I Fill ❑ Both C] Other ❑
Dredge ❑ Fill 0 Both ❑ Other ❑

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From Sammy Vamam
Subject Consent Form from Sammy Varnam
Date. May 4, 2016 at 6.27 AM
To- Tymon Taylor
Please sign and return the form attached.
Samm% Vamam
1574 MonsterBuck Estates
Supply, North Carolina 28462
910-443-4245
0A
NCDENR
1.c1h �aro;ina Cepartment of Environment and Naturai Resources
Division of Coastal Management
%ttchael F _a3ley Goremor Charles S. Jones, Dirwor ; r,lbarn G Ross Jr :ecretarr
Authorized Agent Consent Agreement
Sll i7 A7 1 J , nQn? is hereby authonzed to act on my behalf
c.-., W veins of Ag")
in order to obtain any CAMA permit(s) required for the property listed beiow. The authorization is limited to the
specific activities described in the attached sketch.
LOCATION OF PROJECT:
Lo4-
19
PROPERTY OWNER MAILING ADDRESS.
X rYMCn/ 2
3/ /` L A,rr l m✓r LEI/
19,. tee_ - ., A Ix -7.IA10

PHONE NO. Rlt/- 443-14,245—
Signature of Property Owner:
Signature of Authorized Agent:
Date. Y- o?,- I
i Z' Cardh* Cnve Ext, M"ngton, NoM Caroms 284M3845
Phone: [phone] t FAX 910.3W3964 t intem is mm rmoasimmanagementnet
An E,.jm Cn0mw* 1 AUwva ACNon Ew#glW - 50 •u Reocied + + . Pit Corownr P3W

DIVISION OF COASTAL MANAGEMENT
:ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying �-r—
PP Y g For Permit: VAon71oui 6
--
Address of Property: 16 {— (Q pptlil t'Srf J/'1 l
(Lot or Street #, Street or Road)
(City and County)
I hereby certify that I own property adjacent to the above -referenced property. The individ
applying for this permit has described to me as shown on the attached drawing the development tl
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coas
Management, 127 Cardinal Drive Extension, Wilmington, NC 28405 or call 910-395-39
within 10 days of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boat house or boat lift must be s
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (Ify(
wish to waive. the setback, you must initial the appropriate blank below.)
I do wish to waive the 1
setback requirement.
I do not wish to waive the 15' setback requirement.
A lmmr-§W-U�.

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