59298D - Poole

'�CAMA / ❑ DREDGE & FILL
ENERAL PERMIT V Previous permit#
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
rized by the State of North Carolina, Department of Environment and Natural Resources f
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC l ZL
�Je
- Rules/ jattached.
nt Name , �, Project Location: County Vy11 wl (AIL
s f ' Street Address/ State Road/ Lot #(s)
A p✓ State KG ZIP 293 q � u n ar► b r-
# l l �� ) a j— S2- 40 Fax # () Subdivision N p
ized Agent City ZIP Z� 4
d r- CW EW .PTA ❑ES ❑ PTS Phone # (1110 )'iLt3"203& River Basin Lv al
❑ OEA ElHHF ❑ IH G UBA ❑ N/A Adj. Wtr. Body i. 0 AA 21 (nat
❑ PWS: ❑ FC: �' 1 `
yes no PNA yes no� Crit.Hab. yes / no
Closest Maj. Win Body W
A Project/ Activity
lock) length
M(s)
pier(s)
length
umber
:ad/ Riprap length
vg distance offshore
iax distance offshore
channel
ubic yards
V r
)us �`
:use/ Boatlift
Bulldozing
ne Length
notsure yes
gs: not sure yes no
mum: n/a yes no
Av.e,�
no
Attached: nn
ling permit may
(Scale: I //
�ed by: I OW 11 G r W Q6i I511 I PA (11" ❑ See note on back regarding River Basin
--Id.I I?rt, A.A &I1 iW,,.1K­7 �,I c4,:1, A,_, C„). _.e ,­v ii..1.. .

0

AND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FORA PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own propertyadjacent to 11 PJf— 's
(Name of Property Owner)
La 4 , -\
property located at
t CA- v%4111/IN nCJf
(Lot, Block, Ro
on CA ��� �, , in a(�h( e- ?,)-f' C( 6 �- , N.C.
(Waterbody) (Town and/or County)
Applicant's phone wiling Address:
' le 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 (I T) from my area of riparian access unless
waived by me. (If you wish to waive the setback, you must initial the appropriate blank
below.)
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
;-?n 1�1 f �P, "� Q �:. �-
(Riparian Property Owner Information)
Signature

AND DELIVER
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent to 's
(Nxm_t of Property Owner)\
property located at y L_o j, P I— �
(Lot, Block, Road, etc.)
on -1 - A A , \ , in l`�( E„�„+�`: 5� Ui W CL L , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:9b4?5' U5( Mailing Address: 30-1 C,4&AP_1_gL)R4
r cfa_d &C QV324A
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
Fh 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)
304 c_.A4001 �2
Mailing Address
001, Trip t & k - a �?,A r?
(Riparian Property, Owner Information)
S i nature

IS MAIL
CERTIFIED MAI1, — RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
me of Property Owner: , DEE,
ldress of Property: / ) 0ij N00 T , 6 ('� S q �n
(Lot or Street' ,Street or Road, City & County) n
)plicant's phone #: q/0 ' 525Jo,-%� Mailing Address: c - &�
P'�'"A qJ
ereby certify that I own property adjacent to the above referenced property. The individual applying for this permit
s described to me as shown on the attached drawing the development they are proposing. A description of drawing,
th di ions must be provided with this letter. �+
I ave no objections to this proposal. I have objections to this proposal.
ou have objections to what is being proposed, you must notify the Division of Coastal Management (DC-M)
writing within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext.
Wilmington, NC 28405-3845. DCM representatives can also be contacted at [phone]. No response is
nsidered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
inderstand that a pier, dock, mooring pilings, breakwater, boathouse, or lift must be set back a minimum distance of
from my area of riparian access unless waived by me. (If you wish to waive the setback, you must initial the
1propri e blank below.)
I do wish to waive the 15' set back requirement.
I do not wish to waive the 15' set back requirement.
�C-A ctl\ 6)UQ-1-
4ailing Address C r� Q /
'419PA Air-
Pro
SiS�wfbre
me— e�
rint or Type Name
1D, IAA-
Mailing Address

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
r Eaves Perdue Braxton C. Davis
for Director
AGENT AUTHORIZATION FORM
Date:
f Prope Owner Applying for Permit:
�D"
Pole-
Mailin Address:
;( Ow4
lumber ROO) Ii� 7 S — 64G)5(P
Dee Freeman
Secretary
Name of Authorized Agent for this project:
, e%r am
Agent's Mailing Address:
,`/
001
pia IkIlE S-)IIIZ
Phone Number (�o 3 --ao3 3
hat I have authorized the agent listed above to act on my behalf, for the purpose of applying
)btaining all CAMA Permits necessary to install or construct the following (activity):
)roperty located at 9,1-/ lao.Pi n 614&
ificatio is valid thru (date)
�roperty Owner Signature
V-i9-/.2
Date

50
��1k t Lea
< aye -�
fc— 10 ---

)plicant: L Y ►
ate: r
q 19 �2
Permit #: C P '59 2-9 S I
!scribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
ind in your Habitat code sheet.
bitat Name
TOTAL Sq. Ft. FINAL Sq. Ft. TOTAL Feet
(Applied for. (Anticipated final (Applied for.
DISTURB TYPE Disturbance total disturbance. Disturbance
Choose One includes any Excludes any total includes
anticipated restoration any anticipated
restoration or and/or temp restoration or
temp impacts) impact amount) temp impacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/or
temp impact
amount)
�W
Dredge ❑ Fill ❑ Both ❑ Other
1 ZC
' 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 ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑