64060D - Barkley

CAMA / ❑ DREDGE & FILL
Previous permit #
iENERAL PERMIT
Vew ❑Modification ❑Complete Reissue []Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources -71 1
)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC r7 mules attached.
Name - S.S I i
t,_--_-_ State : ;- ZIP 1 `
rwT
A Agent
❑ CW [�•EW EjJOTA ❑ ES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS: ❑ FC:
Project Location: County i32i 11_si s iE be
Street Address/ State Road/ Lot #(s)
7L4 W, '' ' OK.
Subdivision
City 0,11-K I SL 07-0 ZIP &— SOU
Phone # ( ) River Basin 4L um
Adj. Wtr. Body Li1S :7�'A/
Closest Maj. Wtr. Body f4l �Q LA)
yes /, no';; PNA yes / fjo crit."aD. yes i no
Project/ Activity ' I V ek7X v't L 1' JV6`( V-
(Scale:
tt _
:k)length X
i(s) I �' x 1 Ivy
ier(s)
ngth
tuber
d/ Riprap length
distance offshore
uc distance offshore
cannel
bic yards
np
ise/ Boatlift
iulldozing
VL- UeV — i
ie Length
not sure yes,
gs: not sure yes
i. .
rium: n/a yes
yes
Attached: yes
ling permit may be regL*i!c
T ❑ See note on back regarding River Basin

Date
Check
Check
Received
Check From (Name)
Name of Permit Holder
Vendor
Number
amount
I Permit Number/Con
11/25/2014 Backwater Marine Construction Inc.
Klutz
BB&T
1731
$200.00 Klutz GP
11/26/2014 American Marine Construction INC (Charles Perry Margaret Wagstaff
First Citizens Bank
85738
$400.00 GP 64059D
11/26/2014 Village of Bald Head Island
same
PNC Bank
57163
$100.00 renewal fee, 208-86
11/26/2014 Allied Marine Contractors LLC
Berkley
B of A
6957
$200.00 GP 64060D
11/26/2014 Bruce Marek, P.E.
Waddell
Wells Fargo Bank
1409
$400.00 major fee, Waddell, B

Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
'ound in your Habitat code sheet.
labitat Name I DISTURB TYPE
Choose One
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
I
and/or temp
temp impacts)
impact amount)
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated final
Disturbance
disturbance.
total includes
Excludes any
any anticipated
restoration and/or
I
restoration or
temp impact
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Othere�'
L' '
I
Dredge ❑ Fill ❑ Both ❑ Other [ (�
t 0 Q
Dredge ❑ Fill ❑ Both ❑ Other p� S7c�
S 70
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 0 Both ❑ Other ❑

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date /
Name of Property Owner Applying for Permit:
Mailing Address:
K-/� a o- L?)1,mk
I certify that I have authorized (agent) �%f ,�,) 41,� <��"to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity)
' J
at (my property located at) L,
This certification is valid thru (date) S
A:�)J�5
Prhnorty nwnor Ciarnatnrp
ilota

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
i hereby certify that I own property adjacent to iL Or _ e• z 's
A (Name of P operty Owner)
property located at _� i ;x
(Address, Lot, Block, Road, etc.) J
on ;:, in%t.1L-�,5J.-� c/ AC.
(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)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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)
/'`l ,
Signature
Print or Type Name �
. iJ
(Adjacent Property wrier Information)
Signature / l�
Print or Tye Name

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -i(Ir � 1'(', S
(Name of P onerty Owner)
property located at
(Address, Lot, Block, Road, etc.)
on i�%; �% in C �� �,5kN.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must gill in description below or attach a site drawing)
61e,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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)
Signature
Print or Type Name f
(Adjacent Property Owner Information)
Sig ne
x- lLf'o� r
Print od�rpe Wme 9

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