69020D - Williamson

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Comments
3/23/2017
Carolina Bluewater
Construction
Kelly Williamson BB&T 17262 $200.00 GP 69020D

NC Division of Coastal Mgt. Habitat Impact Cord
Applicant: K'e
Date: 62JlV;`a.61-7
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.
V
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
di
Habitat Name
Choose One
includes any
Excludes any
total includes
E;
anticipated
restoration
any anticipated
re
restoration or
and/or temp
restoration or
to
temp impacts)
impact amount)
temp impacts
ar
Dredge ❑ Fill ❑ Both ❑ Other 14l
I
Dredge ❑ Fill ❑ Both ❑ Other
O
'l
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: VU I 1 Ai D
Mailing Address: ax I rocs
'��Al/Ile Ile
Phone Number: ?167 533 5 35
Email Address: r/tJ� /�/Gt�'jj��7�'lCD
I certify that I have authorized �(X1'�l//�G� &v-&IAZP�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: Pj � 2 k /./ /-:7'��
at my property located at 31 U�H/&N
in &W�OJICAL 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:
Title

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PIL17VGSBOATLIFTBOATHOUSE)
I hereby certify that I own property y adjacent to f
s
(Name of Property Owner)
property located at��-
-� i A (Lot, Block, Road, etc.) IJ=
on I►1 tl-(./ c �sin_ O� �JE✓-Y ' I
� � , N.C.
(Waterbody) (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/boathft/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 proposin development)
(Applicant Information) (Riparian Property Owner Info anon)

ADJACENT RIpAPJAN PROPERTY OWNER STATEMENT
(FORA PIER/MOORI�rGpLUIVGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to
's
Property located at
(Name of Property Owner)
�S� g'-'
On-, T O`0� Bloch, Road, etc.)
(Rraterbo y) t7- 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/boatli$/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
DESCR MON AND/OR DRAW'NG OF PROPOSED DEVELOPMENT• —�
(TObe filled in by individual proposin deyelopme)
;7
(Applicant Information) ��-------------_-------------�__________� _�w
MarkngAddress ,/
i-
4aajdwe Ok
n
�P Owner Inforo�ation)
� e

ATL
rs +v
8o' SETBACK FROM
F DCE OF DREDGE CN
r I C R L M i U U I r L M N
C Ckpyrlgkt 2012
ALL RIGHTS RESERVED
Iou.

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �� -/ �_r ^-� 's
(Name of Property Owner)
property located at S� CD�. ��` 34 --
(Address, Lot, Block, Road, etc.)
on in Q c-e.,k,r✓ 1-_, (.- d e.-,- 4� N.C.
(Waterbody) (City/Town and/or County)
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)

Y I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
Sig
rint orye Name
Mailing Address
Dc,, - e,,4- 59'e -U ijd y
City/State/Zip 3
ale-- ' 1 6 s'"
Telephone Number
f-- 7-- 2y/ r7
Date
(Adjacent Property Owner Information)
S!Mz��
'
G,,/,'
Prin/or�pe
me � y�
M iling Address /
City/State/Zip
Telephone Number
Date
(Revised 611812012)