59199D - Graves

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CAMA / DREDGE & FILL n i9.7
GENERAL PERMIT ✓ Previous permit #
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued '-:
)rized 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 atpched.
it Name ) �Nf� L l� %; ��f3 �F. S Project Location: County l/�lzi
State/VL- �ZI P 7S `
Fax #(
zed Agent
i ❑ CW ❑ EW PTA J ES C_I PTS
❑ OEA HHF IH UBA C' N/A
❑ PWS: FO
yes / no PNA yes / no
if Project/ Activity
xk) length
n(s)
pier(s)
I
ength
ember
ad/ Riprap length
(g distance offshore
iax distance offshore
:hannel
i
ibic yards
mp
use/ Boatlift
3ulldozing1-4
_.. -
ie Length
not sure yes 60711
riu n: n/a yes s 4n,
3s� Y)
yes
Attached: yes Ano
ing permit may be required by:
Crit.Hab. yes / no
A 14 D44
Street Address/ State Road/ Lot #(s)
IA4Z
Subdivision
City r ! S ZIP
Phone # ( — River Basin _
Adj. Wtr. Body /L-��J(�- (nat
Closest Maj. Wtr. Body
(Scale: /it.
❑ See note on back regarding River Basin
l /

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to KonAldy/ui, "'S I
(Name of roperty Owner)
property located at �� y �rP��v; Pw r-,
(Address, Lot, Block, Road, etc.)
on in , N.C.
Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
z k(
3 y
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
c� 'L -,
Sign ture
P,
PriAt or 7ype Na e
(Adjacent Property Owner Information)
` Signature
�C Print or Type Name

-4.

(12 08:20AM EST HPMI, Inc. ->
9103294481 Pg 1/2
HPMI, Inc.
Phone: [phone]
Fax: [phone]
LM
To:
From: Martln Evans
Fa)c 9103294481 Pages: 2
Re: dock dox Date: November 09, 2012

�.r-rrtseby certify that I own property adjacent to 0111AM y/a 41 e3 s
/ , (Name of roperty Owner)
property located at '72 � � l iP�,�v4 (w 7-t
/ (Address, Lot, Block, Road, etc.)
on l , in N.C.
Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner Information)
K 01
A4,"L-,
Sign, ,}tune
Pr t or Type Name
-y4L r gAL 14411-5
ailgddrepssl' 2 SYf
� x
(Adjacent Property Owner Information)
7.i nature
wi/I ie bvlllU
Prime r Type N e
Mailing Address
�/ lldhas �Ii Al( ?tyw

1/.12 08:20AM EST HPMI, Inc. ->
9103294481 Pg 2/2
AQJACJNT RIPA51AN PROPERPROPERIX OWNERSTATEMENT
I hereby certify that I own property adjacent to G �� ,S
Name of Property Owner)
property located at
on
In , N.C.
(CltylTown and/or County)
s ti applicant has described to me, as shown below, the development proposed at the above
,
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVIc4,OPMENT
(Individual proposing development must iill In description below or attach a site drawing)
I
3Y
w VER SECTION
I understand that a pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 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 wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Owner information)
Sign tore �
Q ly
!� S
PhIlt or type Name
_'1or rgdQ4
(Adjacent ,4vnet information)
Signatur
Print or Type Nam
h Mailing A AMss

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
rty. Owner Applying for Permit:
D j4J -, (;�;U4S, S
CS;
KI _ c. S 8 ¢mot 7
Cap&
have authorized (agent) BXA,4JaoJ G& &AS to act on ro
purpose of applying for and obtaining all CAMA Permits necessary to
ruct (activity)
y located at) 0 u'f

Permit #: /
scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
and in your Habitat code sheet.
DISTURB TYPE
ibltat Name Choose One
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)
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)
l
a i Dredge ❑ Fill ❑ Both ❑ Oth
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 ❑