62665D - Vickers

6�
l:XAMA / DREDGE &FILL M
1ENERAL PERMIT Previous permit#
New 71Modification ❑Complete Reissue Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environment and Natural Resources
:)astal Resources Commission in an area of environmental concern pursuant to 15A NCAC �j •
❑ Rules attached.
Name /dAqe 4e-'< Project Location: County 'A16; Ak—OA(4/
1✓r /0' State ZIP 40V
( f4 .r f Fax # ( ) "►� '�
.d Agent Ah- 7^
CW EW PTA ES ❑ PTS
OEA HHF IH - UBA -' N/A
PWS FC:
Street Address/ State Road/ Lot #(s)
7 5*
Subdivision ��77�
CityWl ZIP ///sue(((''
Phone # ( ) `"`f River Basin
Adj. Wtr. Body C- �7--e nat
yes / no PNA yes '/ no Crit.Hab. yes / no Closest Maj. Wtr. Body /
A Project/ Activity (_ '► f h L�ll>✓Sr
(Scale:/
ock) length
m(s) la,XG4 -
pier(s)
length
umber
:ad/ Riprap length_
vg distance offshore
iax distance offshore
channel
ubic yards
imp
)use/ Boatlift
Bulldozing
L-M 16 `7
ti t-j 2'Y a
ne Length
not sure yes
i
no
:gs: not sure yes
o
)rium: n/a yes
o
yes
no
Attached: yes
no
ling permit may be requirec

CAMA / ❑ DREDGE & FILL
l :` 6 2 C
NERAL PERMIT
Previous permit #
New ❑Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
!zed by the State of North Carolina, Department of Environment and Natural Resources /
Resources ,+'
�T 1244
oastal Commission in an area of environmental concern pursuant
to I SA NCAC 6/
/
Name—�O C/' S
�
❑ Rules attached.
Project Location: County
+_�_
Street Address/ State Road/ Lot #(s)
_?
ZIP! — ,�h State
�'J7
-_%f"ax #
Subdivision
!d Agent A
tyzip
irW SEWA ❑ ES ❑ PTS
Phone # () ` "^� River Basin
OEA HHF ❑ IH ❑ USA ❑ WA
Adj. Wtr. Body r �r�c nat
El PWS: ❑FC:
'es /(no PNA / no Crit.Hab. yes / no
_5
'
Closest Maj. Wtr. Body �J/%f ,y449
Project!
?%
c) length �
r(s)
gth
ber
Riprap length
istance offshore
distance offshore
nnel
yards
/ Boatlift
Idozing
.11i
��L wr S f v6il ,�1 el, 'of A7 G4!'lrs.s
Length ✓�7;� —
not sureyes �n� 4
not sure yes V --
m: n/a yes .` <
o
ache o
perrryt�may be required by:
pecial Conditions�1�
(Scaleril
=j?G
$note on back regarding River Basin

HAD N
North Carolina Department of Environment and Natural resources
Division of Coastal Management
Pat McCrory Braxton C. Davis John E, Skvarla, III
Governor Director Secretary
AGENT AUTHORIZATION FORM
Date: 3
Name pf roperty Ova r Applying for Permit: Name of Authorized Agent for this project:
Owner's Mailing Address:
r
Agent's Mailing Address:
s
Phone Number( ) �4.5 6 3� -/q/�l Phone Numberf �/al 1 � i - 5'5/-1
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Perm4s necessary to install or construct the following (activity):
For my property located at
This
thru
lrqf!O Owner
10t812Di3
RECEIVED
DCM WILMINGTON, N
0 C T 092013
61 aers (N/h+,4- 0" /)ee-A

m
►"
I

HAND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTIBOAT'HOUSE)
I hereby certify that I own property adjacent to A� 'f'-e—s 's
(Name of Property Owner)
properly located atQgl/✓r !�
(Lot, Block, R d
on %,'7 , in N.C.
7r (Waterbody) (Town and/or County) "
ApI►licant's phone fi!: 40Mailing Address: ift.d
lie 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-
---------------- 7 — --------- --- — --- 7 ---- — --- — - -
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
49�✓s ��wr%rT�p oil/ �/'�0���
y
(Information for Property Owner Applying
for Permit)
707
Mailing Address
G` /'4"'1/V?�
City/State/Zip
(Riparian Property Owner Information)
Signature
Print or Type Name
y �zy �i8Z-:�v
Telepho/n,WY46mber j L Telephone Number
—

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOOREVG P.f-MGSBOATLLF.TBOATIIOUSE)
� �. s. r (Z.
I hereby certify that I own property adjacent to �.t% 's
�--' (Name of Property Owner)
property located at /7✓i'9c�y ,�j®j,✓r- j�;-7� ,
(Lot, Block, Road, etc)
on Al ' x:f-S - --�. . - - /mil//G�ii / l� r�% , 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 / boatl / 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.)
k,"" I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To befdled in by individual proposing development)
Q� �o�p� 62'�' .G.�.✓�' . � �� s v 5,9r✓ G���'-�'T'� `a P/��''�•�si',..9�
121
RECEIVED
DCM WILMINGTON, NC
0CT092013
(Information for Property Owner/Applicant (Riparian Property Owner Information)
Applying for permit)
Mailing Address Signature
City/State/Zip Print or Type Name
Phone %��bes �, Mailing Addess, City, State, Zip