63167D - Lassiter

CAMA / DREDGE & FILL
3ENERAL PERMIT Previous permit#
Y]New 'Modification (-]Complete Reissue ❑Partial Reissue Date previous permit issued
irized by the State of North Carolina, Department of Environment and Natural Resources N'91 z C
P
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
1 ules attached.
it /Name Y- Project Location: County j�l U ll�fr.11 a",
i J Street Address/ StateRoad/ Lot #(s) ..
State NL ZIP all V, �IYI&LA mG
( ) Fax # ( ) Subdivision ' -OV-S t 1 (, (. --
ted Agent CAL Wa4 ✓ /1� Q n r�� CityU ZIPS-�
ElCW ; EW ( PTA ❑ ES ElPTS Phone # (` � li) L Y River Basin
❑ OEA ❑ HHF ❑- IH ❑ UBA ❑ N/A Adj. Wtr. Body w
nat
❑ PWS: ❑ FC:
yes no PNA yes / no Crit.Hab. yes no Closest Maj. Wtr. Body
f Project/ Activity 1'J (J1 h W K W * f1 \ A l tAr1 \ {"Z{ f (
)ck) length
mgth
amber
id/ Riprap length
g distance offshc
ax distance offsh
hannel
ibic yards
mp
use/ Boatlift
lulldozing
ie Length
T-
not sure
yes Pno
;s: not sure
yes
rium: n/a"'
yes no
I
yes no
Attached:
yes--_
ing permit may be required by:
(Scale:
i ❑ See note 9n back regarding River Basin

DENR CAMA Dailv Check Lop for WIRO
Date Received
I Check From Name
Name of Permit Holder
Check Number
Check amount
Permit Number/Comm
6/18/2014 Grice Construction of Brunswick County John Teague
6/19/2014 Hammocks at Shallotte Pointe LLC
6/20/2014 Villaver Law Firm _ Steven Villaver
6/23/2014 j Bank of A Money Order Brandon Grimes
Brandon Grimes
6/23/2014 Carolina Marine Construction, Inc Cord Grass Bay HOA
6/23/2014 Reggie W. Bames Jr
6/24/2014 Charles F. Riggs & Associates Inc. Giles Jeffreys -& Lee Thornton
Jason Dixon & Lee Thornton _
_ Mike_Turbeville & Greg Coiner
6/24/2014 Richard L. and Erica J. Penny
6/25/2014 Clements Marine Construction Inc Dan Smith
_
6/25/2014 Snow Marine Construction & Dredging, Inc Charles Ashley Mann
6/25/2014 Elite Homes By Forrest Taylor, Inc. Cableu, LLC
6/25/2014 Grice Construction of Brunswick County H & H Construction
H & H Construction
6/2512014 Kleigh M. Prevatte Mike Cecil
6/25/2014 Backwater Marine Construction, Inc Craig Brady
Jim & MaryBeth Yeager
,John Lassiter
9702
1053
5992
$200.00
S100.00
$200.00
$497.00
63266D
.GP _
modification of MP #93-08
GP 63202D
1139200122
Vio# 14-03D B & B Marine
1139200122
_
+ GP 63955D ($47)
$400.00 GP 63957D
$100.00 Transfer fee #70-09
$600.00 GP 63952D @$200
9105
1200
13510
GP 63954D $200
_
I GP 63953D $200
535
$200.00 GP 63924D
$650.00 GP 63962D @$400
- Major fee (Smith) @$250
$250.00 Major fee (Mann) NHCo
$200.00 GP 63973D
$400.00 GP 63958D @$200
GP 63959D a@$200
3488
2839
_
8046
9710
1001
$200.00
_ $800.00
GP 63960D
GP 63296D @$400
GP 63297D @$200
GP 63167D (cD$200
40557

NC Division of Coastal Mgt, Habitat impact Computer Sheet
Applicant: `^ l /I SS1 Y Perm it #:
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measureme
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 impacts)
FINAL Feet
(Anticipated fir
disturbance.
Excludes any
restoration an(
temp impact
amount)
Dredge ❑ Fill ❑ Both ❑ Other
`
I
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 El Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson Dee RE
Governor Director Sec
AGENT AUTHORIZATION FORM
Date: /_ i _/ Y
Name of Property, Owner Applying for Permit: Name
%of Authorized Agent for this project:
Owner's Mailing Address:
Phone Number
Agent's Mailing Address:
f � o -, 7 /1,.� , , , , � S
.S 1�
Phone Number ��) 41, 3 —
I certify that 1 have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
Rerno��- -t-ne_ VAt3C-,� Z)oe_ Ic nerd pAMP and.
Permcne_n4 P, er I 7Vc e:
(my property located) at 3 ') 11 nlP S `"f f 1-T---II
This certification is valid thru ( ate)
G
Property Owner Signature Date

l9
teA, - M �
qlv- I-IZ13W- Y S
�4wl r (o 44 A
t� 119
0 w to "P- /Z
---'I - , l
�r,/,6AJ ha�l'�
I ` B Al ��

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
ew
(FOR A PIERIMOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to is
(Name of Property Owner)
property located at ,3 r7 �N t J.
``
(Lot, Blo4
on_ � , C , in _
(Waterbody)
e � ��
Road, etc.)
(Town and/or County)
NC—
Applicant's phone #-. 9 ,' i- l- tN -"13 Mailing Address: y3S 4v,-L-
N.C.
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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
---------------- -------- --------- ------------------------------------
DESCRIPT ON AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(4 3 % R�N 4�1e_ (ZA— 6a,\Ac
City/State/Zip VC
-------------------------------------------------------
(Riparian Property Owner Information)
Signature
•ADS � �l- e" �iLS S
1 Print or Type Name
i3 i w ^,1_n a")' r

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERMOORING PILINGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to
property located at / L ' ') `l
(Lot,
(Name of Property Owner)
- r+ 1`
Road, etc.)
I
.R z.
on 1 L w , in N.C.
(Waterbody) (Town and/or County)
Applicant's phone #- 70y 61 V - 95'73 Mailing Address:
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 / boatlift / boathouse
must be set back a minimum distance of fifteen feet (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 not wish to waive
I do wish to waive that setback requirement.
----------
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying (Riparian Property Owner Information)
for Permit)
e(no l.c<s5 cr
Mailing Address
t/ 3 � �/Vt-_ 4 Nc
City/State/Zip
Signature
Print or Type Name
. -- , --7 r/ h