61693D - Boone

`1CAMA / ---'DREDGE & FILL 61
GENERAL PERMIT Previous permit #
,New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
orized by the State of North Carolina, Department of Environment and Natural Resources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
❑ Rules attached.
nt //Name calf t. t A-ys^ �NI�G /�e7A4- Project Location: County �i�sli2H/
�s (O�'�� �,iiLt Street Address/ State Road/ Lot #(s)
CMM&Gc StateNcG ZIP 7'" S716 /G a' 1 �' ''r- 5
# U10 540 - Fax # ( ) Subdivision ! /
ized Agent AL
� (� I,1 �1.4... City 5ti/- Ll ZIP ,Z�❑CWW ATA J ES ❑ PTS Phone # ( ) ' River Basin
d J OEAHF IH UBA ❑ N/A Adj. Wtr. Body LfG 04 /5 1 � ��/ > rI ` (nat
❑ J PWS: FC: 9 �: ✓h /� �l�tJrr -
yes / o no PNA yes / Crit.Hab. yes /(� Closest Maj. Wtr. Body
Df Project/ Activity �:' - 'c ✓�d�� �E_��s'��
length
pier(s)
length
camber
gad/ Riprap length
vg distance offshore_
nax distance offshore
channel
ubic yards_
imp
)use/ Boatlift
Bulldozing
r
ine Length _
not sure yes
rgs: not sure yes
)rium: n/a yes
yes
Attached: /yety `
Ping permit may be required by:
A-1
(Scale:
❑ See note on back regarding River Basin
I_ - \ 1 ._.rr 1-1 1 `., r ..

iplicant: v " // (a f2/ ,p Permit #: /
1 11 C� � G
� �z /3
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
)itat 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 FINAL Feet
(Applied for. (Anticipated final
Disturbance disturbance.
total includes Excludes any
any anticipated restoration and/or
restoration or temp impact
temp impacts) amount)
Dredge ❑ Fill ❑ Both ❑ Other
zZ
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 ❑ Fill ❑ Both ❑ Other ❑

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOIL A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to %ti j�q„ctt6L&A,je- 's
(Name of Property Owner)
property located at
(Lot, Block, Road, etc.)
on �,4/1JA C. , in 6 a� 21 N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: / — 1Vlailing 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
for Permit)
Mailing Address j Signature
� I
(Riparian Property
tion)

WESTERN UNION FINANCIAL SERVICES INC. - ISSUER
1,, A Wells Fargo Bank Grand Junction - Downtown, N.A., Grand Junction, Colorado Englewood, Colorado
14-704983315
5735 D 061213
38
4983308
155 L 000183 $ 200.00
QS AND NO CENTS
=,AYMENT FOR/ACCT.
PURCHASER'S SIGNATURE
t, 7 0 t, 9 a 3 3 15 5 111

T "T.
T£
Y N y
mil. q
3
7
T'C ,jY4aN

,� �. ��
...,f.
;�_,
�k
��' �
1IR-'--�, � _ _ .�...p.
',
r� a"e_� " �� ``� � xnP
i r *:, aa_

HC®ENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue Braxton C. Davis
Governor Director
Dee Freem�
Secreta
AGENT AUTHORIZATION FORM
r
Date:
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
6 t L LA A� l yOA N t r_ f� titKl E 9 RAh1f (OAt04
Nner's Mailing Address:
(n lam? LJr+tTT
Agent's Mailing Address
lone Number6jq) t9wyqA65_ Phone Number (91z) 1 a ? / 3,,�_
ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
1JEhj
r my property located at I Zr
s certification is valid thru (date) 1 j
Property Owner Sign ure Da e

f: hcd /)k4 �--
CERTIFIED MAIL — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
Name of Property Owner: W 1 t_L 0% "A 1>AWlL ZC�)ON
Address of Property: I nSt I ST 6L j21- C,._!TY. /fit. C
(Lot or Street #, St eet or Road, City & County)
Applicant's phone #: l`l ' �`tT(� Mailing Address: /'S�Dq AD-
G CR 14 116T-74
I hereby certify that I own property adjacent to the above referenced property. The individual applying for this pel
has described to me as shown on the attached drawing the development they are proposing. A description of draw
with dimensions must be provided with this letter.
I have no objections to this proposal. I have objections to this proposal.
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DCl
in writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive 1
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
considered the same as no objection if vo❑ have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distanc(
15' from m rea of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
app pr e blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
(Property Owner ormation)
Signature
�4— 1 LL.4.4%-t —DAW F—L
Print or Type Name
AD508 1,A4cTTFr-'-, 96)At>
(Riparian Property Owner Information)
9/0-etz�
Si a re
a � /2— 4A Lc,
Print or Type Name
3 � C) ( 4 V'Qx�
Mailing Address
Mailing Address