59297D - Hostelter

'-�CAMA / ❑ DREDGE & FILL
q!NERAL PERMIT Previous permit #
w ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
prized by the State of North Carolina, Department of Environment and Natural Resources zoo
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
' ' , Rules attached.
nt Name j Ct 1 ©�64Project Location: County U As" I dk'
> -Z Street Address/ StaEI(A
Road/ Lot-#(s)
State _ ZIP JI _14
Ot ,C'Fax # ( ) Subdi 'ion
zed Agent Pty)�f U ZIP Z�'l!p
j ❑ CW IEW KPTA ❑ ES ElPTS P ne # (M )-1 - 000 River Basin
ElOEA /❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body nat I
ElPWS: ❑rnoT
[� , ll '
yes / no Pill yesCrit.Hab. yes no Closest Maj. Wtr. Body /� I �� W
if Project/ Activity l t��l'VI_ �- oq � U t o t'tt to n AA�� i� A
(Scale: I /-
ock)length
pier(s)
ength
umber
ad/ Riprap length
ig distance offshore
iax distance offshore
:hannel
jbic yards
imp
use/ Boatlift
3u dozing
22)� !U
ne Length �2 u
not sure yes en
gs: not sure yes
,rium: n/a jny-s
no
�../�Attached: yes no
ling permit may be required by: I 1 1 r 1 6 )U 6 (W� ❑ See note on back regarding River Basin i
. - .. - -- - '-L 1 17 . i n .,. ,.I All , .1 C.. ..- - i i- -i . ,. . ,.I LA-1 I , i„ - . i - i;' ..

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WDENIR
;-h
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
3everly Eaves Perdue Braxton C. Davis
3ovemor Director
AGENT AUTHORIZATION FORM
Date: 8 1/7 Z
Dee Freen
Secrei
ame of Property Owner Applying for Permit: Name of Authorized Agent for this project:
/ V
tuner's Mailing Address:
u
I " id. 1 -7-1 A q�sl �
lone Number (SW RIIS - �f 163
Agent's Mailing Address:
f4itkur nl. c. z e 6 o i
Phone Number (PZe) ff(b--cuL.)7
ertify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
and obtaining all CAMA Permits necessary to install or construct the following (activity):
it my property located at 6l qY&i�&OLL
is certification is valid thru (date) QltO
N L-\� <�(I aa (I I
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PMWOORING PIE VVGSIBOA TLIFIBOATSOUSE)
I hereby certify that I own property adjacent to
property located at
(Name of Property Owner)
V,
I
(Lot, Block, Road, etc.) e
on aVl YVI AG�.I ('A VA 41 , in �U YI�C� G 3� G.N.C..
(Waterbody) (Town and/or County)
Applicant's phone #: =' 7��v°7S_ �� .3 Mailing Address: ;2¢ 3 ¢2 ukI N
k-1,t 114rT, XN- -f(e.S/7-g) 9 g
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. (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.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
City/State/Zip
(Riparian Property Owner Information)
Signature
(!
�r Print or Type Name
q, v — S - c> g 63

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIERIMOORING PILINGSBOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to 0 c ar� a 00 STe'f
1« 's
(Name of Pro erty Owner)
property located at �� o L I'
(Lot, Block, Road, etc.) , /
on C4 N � I , in St.�� Pe' � , i ( -28R, g , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: S W - °0 7S-416 3 Mailing Address: 2 43 f2 a(4n � Z
.F7 Kkg,+ I TN• 'A4S17— 9) 9
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 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.)
tjlL
I do not wish to waive
I do wish to waive that setback requirement.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT:
(To be filled in by individual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
(Riparian Property Owner Information)
C /J
Si ature [�

E

pplicant: �� VV tQY C/` Ov4c4cy-- Permit #:
ate: C� 1
: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)
SDredge ❑ 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 ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
'; Xq (nC4