60786D - Davis

`'CAMA / DREDGE & FILL / NO. 60
GENERAL PERMIT V Previous permit y�J.r
�dNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
prized 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 �1
r ❑ Rule attached.
nt Name ! �L I AM AY)S Project Location: County •!ik `
s%26 A Street Address/ State Poad/ Lot #(s)
State tl C ZI Pz,'5 t"1 '-f3
# 0) Fax # ( ) Subdivision
izedAgent &P,/L- City 74Wf�Ay.� �!!( ZIP
d ❑ CW )6EW ETA ❑ ES ❑ PTS Phone # (_ ) -- River Basin
OEA ❑ HHF ❑ IH UBA ❑ N/A /'1r ,� G C IQF.�,�
❑ PWS: El FC: Adj. Wtr. Body �J
PNA 15e �/ no Crit.Hab. yes /&o Closest Maj. Wtr. Body
A Project/ Activity
ock)length
m(s)
pier(s)
length
umber
ad/ Riprap length
vg distance offshore_
iax distance offshore
=hannel
ubic yards
imp
Puse/ Boatlift
tit tN
Bulldozing r
bu �( r ...
i
ne Length `f� r5Ol
i
not sure yes
gs: not sure yes
orium: n/a yes C—
ling
yes
Attached: yes
permit may be required by: _
(Scale: I � �
_ ElSee note on back arding River Basin
Y.
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CLEA,fEN,FS
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7tAD," 910-27o-gl 10 COAISTR UCnoN
NC28443 IATC
ke'rthe
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Bust Citizens
ank
or
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1: , 053 400 3001:
�
0 20
Dollars
2920
66-3"31
365

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORMG PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to h )1 J J ►a rY1 —Day l 5 is
(Name of Property Owner)
property located at LD3 t o)5 VJ
(Lot, Block, Road, etc.)
on �or R 0,rP.e C XS (. , in �V ` CD , 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/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
�( I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
-� 0 1iAM QAvi.5 I
b o 5 X'7l ;
64 a,
(�x1b
w
jameS WAI VAe5
('o l Avlh5 VJ -

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to 11W 11 Ia f)l —0hu i 5 is
(Name of Property Owner)
property located at �p ?, j �Vro)5 VJ
(Lot, Block, Road, etc.)
on �yrb (',reek �x5�. , in �g rt�V' CD , 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/boatlift/boathouse
must be set back a minimum distance of fifteen feet (15') from my area of riparian access unless
waived by me.
I do not wish to waive the setback requirement.
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
��►11;G'► �oavi,5 I
rac l �Ke I boa Av1h� �-
bo5 s I �01 1IvJhs V
Y, /SJ
S

A`Ti'-w,.-Y,wAA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
overly Eaves Perdue Braxton C. Davis
overnor Director
AGENT AUTHORIZATION FORM
Date:
ne ofP/aroperty Owner Applying for Permit
/I/ — W� %
�u/ lam( /
ier's Mailing Address:
FIEVVINI".11.1
P-D
P5 2-4P nlc Z-5i 3
ne Number (q/D)��1� - 31�5-p
Dee Freem
Secret,
Name of Authoriz d Agent for this project:
Agent's Mailing Address:
1 /Q2 C i r% L-�
Phone Number (ft) ,620 95 D5
tify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
nd obtaining all CAMA Permits necessary to install or construct the following (activity):
my property located at
certification is valid thru (date)
Property Owner Signature
l i : 494, � '5�D � / //L cif) - ,'_f7Nn
Date

iplicant: .. ;, IV I Y��W
te:
h_-3
�aws
Permit #: G() J U
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
(Applied for.
Disturbance
total includes
any anticipated
restoration or
temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
D Dredge ❑ Fill ❑ Both ❑ Othe
ll ❑ Both ❑ Other ❑l
❑ Both ❑ Other ❑
E
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 ❑