57522D - Lanier

. CAMA / ' DREDGE & FILL �� r
mENERAL PERMIT Previous permit# ` IV
iNew ❑Modification [-]Complete Reissue ❑Partial Reissue Date previous permit issued
-ized by the State of North Carolina, Department of Environment and Natural Resources
:oastal,Resources Commission in an area of environmental concern pursuant to 15A NCAC
/ -. . ,
,�- �" , JJ " `- _ El Rules attached.
t Name L �f/ L //�!l /. Project Location: County ��N�C.�
/ !.c 5 T Street Address/ State Road/ Lot #(s)
oe FAt tf State ZIP 941?U
`- /O) '5-G - Z ��6 / Fax #�) Subdivision
ed Agent i `%' C 1 lls l�'v. City �01015`% ZIP 27�•
r
❑ CW ❑ EW PTA -QES ❑ PTS
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A
7 PWS: ❑FC:
yes / no. PNA yes / no Crit.Hab. yes /
Project/ Activity 4 ,�k{ 5%y / l
-IA 1.., k
Phone # b) SZy —Z-�Y,l River Basin
Adj. Wtr. Bo�'4 �/✓ILS t
�i
Closest Maj. Wtr. Body / o/ 251 //r FA"��
21
(Scale:
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igth
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Liprap length
distance offshore
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(distance offshore
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Length
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ig permit may be required by: �— 1YO4 ! ( / / T -"cwA- LJ See note on back regarding River Basin
I/,-^ J- 17.,.E

N D�ET1R
North Carolina Department of Environment and Natural Resources
Division of Coastal Management Dee Freen
Beverly Eaves Perdue James Director Secret
Govemor
AGENT AUTHORIZATION FORM
Date: �`, l T ( /
Vame of Property Owner Applying for Permit-
Y
Owner's Mailing Address:
MEW
Name of Authorized Agent for this project:
M /ice < I
Agent's Mailing Address:
Phone Number (,I/A �� 2
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary top install
loor' construct the following (activity):
This certification is valid thru (date)
Property Owner Signature Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERB-IOORLVG PILIAGS/BOATLIFT/BOATHOUSE)
I hereby certify that I own property adjacent to Zoo /-&Z `�2
9`90 (Name of Property Owner)
property located at __
(Lot Block, Road, etc.)
on �S �' tom_ , indf SA, 2 d,*f-C9r( t�� �1�, N.(
(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 se
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)
-r Arc 41-e�' e t"Ct 7
If you have objections to what is being proposed, you must notify the Division of Coastal Management (DC1YI) in wi
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Est. Wilmington,)
DCM representatives can also be contacted at [phone]_
No response is considered the same as -no obiection if you have been notified by Certified Mail
(Information for Property Owner/Applicant
Applying for permit)
0 x5"32
Mailing Address
City/State/Zip
(Riparian Pr erty Owner Information)
S ignatu
;CAI
Print or Type Mr

cY�
024i
J _l (re t. -x:, Oe -Vmq.
r � �
XI rPOW4py
11'�

AW t-t-N i JUYrlRIA—''N YKUYEK 1 Y U VY NtK 51 A l Lttil1_r i
I hereby certify that I o-wm property adjacent to zo c)
property located at
or,
► 90 (341,
(Waterbody)
Applicant's phone #:
(`came of Property Owner)
v
(Lot) Block, Road, etc.)
in /S?~ a
(Town and/or County)
Mailing Address:
He/She has described to me as shown below the development he/she is proposing at that location,
*d I have no objections to the proposal.
-- - -------------------------------------------------------------------------------------------------------------
�' DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMEN'
CP 2�',, (Individual proposing development must fill in description below or attach a site d
Ga Y'r r ohm r ��( !i�
edo
,7� ha dt-
If you have objections to what is being proposed, you must notify the Division of Coastal Management (I
within 10 days of receipt of this notice. Correspondence should be mailed to 127 Cardinal Drive Ext. Wi
DCM representatives can also be contacted at [phone].
No response is considered the same as -no objection if you have been notified b_v__Certifie_d_P

�Iicant: GUG// li�ll7/ ��
Permit #:.—
e:
cribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
id 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)
Dredge ❑ Fill Both ❑ Other ❑
OD100,
Dredge ❑ Fill ❑ Both ❑ Other
11
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 0 Other ❑

DELTA DOCK & BOAT LIFT
PO BOX 353.2
TOSAIL BEACH, NC 28445
8472
-77
66-30/531
DATE 36,
OF
—D 0 L L A R S
First Citizens
retc1ti
Bank
fizens.com Oc:
7013472ul i:0S3100300i:003S31991Sl.'ll.