62664D - Walters

;-'AMA / DREDGE & FILL , / M
INE N E RAL PERMIT V Previous permit #
New -Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources , L Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
uleS attached.
it Name &h V V f y j Project Location: County hag.C-A A (J(
srale I Street Address/ State Road/ Lot #(s)
�-" Lk. State ZIPZ
t( ) Fax#( )
ced Agent
CW EW PTA ❑ ES ❑ PTS
OEA HHF IH ❑ UBA - N/A
PWS: ❑ FC:
yes / no PNA yes no Crit.Hab. yes
f Project/ Activity , Z5► 1 V ��
lock) length115-'X 1r,
'm(s) ?)'-A ZD
pier(s)
length
camber
:ad/ Riprap length_
vg distance offshore_
nax distance offshore
channel
ubic yards_
amp
)use/ Boatlift
Bulldozing 11
RA m v —f 1 1+
ne Length
not sure
yes
igs: not sure
yes
)rium: n/a
yes
yes
Attached:
yes
ling permit may be n
-- -.-. ^ - -- �-- -
62
Subdivision
City �.i .tip ZIP r'l�
P once # W ) `t' :T-P.311iver BasinY
Adj. Wtr. Body tnat
Closest Maj. Wtr. Body I \ K
(Scale: `��

yC Division of Coastai Mgt, Habitat impact {Computer Sheet
\pplicant: UeW 0�;1 ,� Permit #: �-Z(Ouc+
Date: 1 ©% /�
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
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 fins
disturbance.
Excludes any
restoration and/
temp impact
amount)
Other
Dredge ❑ Fill ❑ Both El Other
�l o
Z' `-'
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 Z[:l Other
TED
Dredge ❑ Fill El Both ❑ Other
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both [I Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

wS11VHiUOd 3AII01IM
990112
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441�1'n
NCDE R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
it McCrory Braxton C. Davis John E. Skvarla, III
,overnor Director Secretary
AGENT AUTHORIZATION FORM
Date: � — / � — / 3
5 e of Property OwqeK Applying for Permit: Name of Authorized Agent for this project:
ier's Mailing Address:
��--
0�3
ine Number( )
Agent's Mailing Address: _
-Ro� 13 (p
Phone Number ("-//`) y13 ? W3
rtify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
ind obtaining all CAMA Permits necessary to install or on truct the following
h r F-1 t3 !1 41 Vt k rL ri2-e,t --))A -,o k o,
my property located at -g 1J u V,rc, S; UT-3
certification is valid thru (date
Owner Signature
Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit: -�P�
Address of Property:
(Lot or Street #, Street or Road)
(City and County
��Vt, � t, � 1 4�� CO -
hereby certify that I own property adjacent. to t e a ove-re erence property, The indtvidu;
applying for this permit has described tome as shown on the attached drawing the, development the
are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
ro osal. tt objections
If. }' /Uhave objections to what is being proposed, please write the Division of Coast;
Management, 127 'Cardinal Drive Extension, Wilmington, N-C 28405 or call 910-796-721
within 10 days;of receipt of this notice. No response is considered the same as no objection
you have been notified by Certified Mail..
WAIVER SECTIOY
I understand that a pier, dock, mooring pilings, break-%%,ater, boathouse or boat lift must be s
bck a minimum distance of 15' from my area of riparian access - unless waived by me. (Ifvc
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.
Sign Na m
date
�V) X (��� Cam+ e m AWI4IA

DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATION/WAIVER FORM
Name of Individual Applying For Permit:
Address of Property: . dt q (;�.
(Lot or Street #, Street or Road)
(City and County)
sere -y cert� that I own property adjacent to the above -reerence property. e in tvt ua
applying for this permit has described to.me as shown on the attached drawing the development they
Are proposing. A description or drawing, with dimensions, should be provided with this letter.
I have no objections to this proposal.
If you have objections to what is being proposed, please write the Division of Coasta
Management, 127 `Cardinal Drive Extension, V�iilmington,.NC 23405 or call 910-796-721-
within 10 days of receipt of this notice. No response is considered the same as no.objection i
you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, break)vater, boat house or boat lift must be se
bek a minimum distance of 15' from my area of riparian access - unless waived by me. (Ifyo,
wish to Nvaive thesetback,-you must initial the appropriate blank below.)
I do wish to waive the 1 5' setback requirement.
I do not wish to waive the 1 5' setback requirement.
Sian Nam Date
C Arin� i�i�mP W"'A.Jh

/S
._y C 1/
vc)6�1 4)r<)�y
m,

Applicant: �/., I . � �,` -
t/W 1 Permit #: Z 0
Date:
Describe below the HABITAT disturbances for the application. All values should match the name, and units of measuremen
found in your Habitat code sheet.
Habitat Name I DISTURB TYPE
Choose One
Dredge ❑ Fill ❑ Both ❑
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 ❑
TOTAL Sq. Ft.
FINAL Sq. Ft.
(Applied for.
(Anticipated final
Disturbance total
disturbance.
includes any
Excludes any
anticipated
restoration
restoration or
and/or temp
temp impacts)
impact amount)
Z10
Z1(,z)
TOTAL Feet
FINAL Feet
(Applied for.
(Anticipated Tina
Disturbance
disturbance.
total includes
Excludes any
any anticipated
restoration andA
restoration or
temp impact
temp impacts)
amount)
Dredge ❑ Fill ❑ Both ❑ Other ❑