62533D - Matthews

(Scale: / i"
i,C r p 1 l4i4 Q�
CAMAS/ ❑ VREDGE & FILL
GENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue [-]Partial Reissue Date previous permit issued -V
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 (
7 -� ❑Rules attached.
t Named J��� �E gf'Aj}� /yj,g 77 Via. Project Location: County pi /✓(�tlL.
Street Address/ State Road/ ,Lot
#(s)
� `C I r State�ZI P r a3 �'!' / U SGl 0 ✓-�I, W
# (� (� Fax # ( ) Subdivision
izedAgent �/%!- City ZIP_
d ❑ CW !SEW +PTA ❑ ES ❑ PTS Phone # River Basin 450—
OEA ❑ HHF IH UBA ❑ N/A //�� //
PWS: ❑FC: Adj. Wtr. Body A/15 1Ar�e. (Hatt
yes /' no PNA yes Tto , Crit.Hab. yes /) Closest Maj. Wtr. Body ��tu u' Jy ✓r'
of Project/ Activity
lock) length
pier(s)
length
camber
md/ Riprap length
ivg distance offshore_
nax distance offshore
channel
ubic yards
amp ��
Boatli 12 �
Bulldozing
ine Length J�
not sure yes
rgs: not sure yes
)rium: n/a yes
yes
Attached: yes
Jing permit may be rr

pplicant:
)Permit #:
ate: .7-l�,13
!scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
bitat 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 final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
C60 Dredge ❑ Fill ❑ Both ❑ Other J�
l Y
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 ❑ Filf ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

)NEY WESTERN UNION FINANCIAL SERVICES INC. - ISSUER
IDEWPayable at Wells Fargo Bank Grand Junction -Downtown, N.A., Grand Junction, Colorado Englewood, Colorado
14-704983316
A 1-:135-735 11 061214:5)
T 1338 03 $
1470A 833164 L 0001 Ry
1 19
PAYMENT FOR/ACCT. #
PURCHASER'S ADDRESS A0
01: 40L47049833&64116

Matthews Boat J.ift Statement - bandbmarineconstruction@gmaiLcom - Gmail#inbox/13£.. Page 1 of
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Inbox (722)
Starred Matthews Boat Lift Statement Inbox x
Important
Chats Matthews, Jack <[e-mail]>
Sent Mail to me
Drafts (85)
All Mail Brandon,
Attached is the South neighbors (White) paperwork for dock approval.
Search people_ :' p L rtu, FiI l!
Bert White I t��5t°tt �
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rn
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4l
Payable to:
RETAIN THIS EY IN
INFORMATK)N BELOW AND txi BACK.
PURCHASE ADREEMnd T You the purchaser agree that Westem Union Financial Services Inc. (WUFSI need 1 61 on, or replace, or refund a bst or stolen WUFSI Manny Order unless (7) you fill in the faro N L u, ). . _ 02 PBn"_°,t
O
.G

1 •_
Ij,
a '
It(?
I hereby certify that I own properly adjacent to ✓ Cl --5erP
ame of Prop
property located at%lU �%Y�r��✓ir ,_
on
N.C.
.The applicant has described to me, as shown below, the development proposed at the above location•
�1717 jp /� I have no objeWon to this proposal.
Cr
I have o*xAlons to this proposal.
DE$GRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
gndmduai proposing development must flit In desoript%on below or attach a site drswing)
to I
I �
M( l�i LIER SECTION
I understand that a pier, dock, mooring pilings, meter, boathouse, lift, or groin must be s
minimum distance of 15 from my area of riparian access unless waived by me. (if you wish
the sefback, you must Initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to walve the 16 setback requirement.
(PropeSrty Owm Inf s) - � nt Pr er Information)
I .fr
Si Fore ire
Print ar Tvna Mum / !, Pdnt or
back a

N'
N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date 4—Z �_ ��
Name of Property Owner Applying for Permit:
Mailing Address:
/g12 /�•"I r'(11 ele f1_1
I certify that I have authorized (agent) ��q.��U� C f�{� to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) P�
at (my propertylocated at
This certification is valid thru (date) 9— � �r- � V -
rty Owner Signature Date