54497D - Allen

CAMA / DREDGE & FILL r"
112,
GENERAL PERMIT Previous permit#
New —Modification JComplete Reissue 7Partial Reissue Date previous permit issued
orize� 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 2,41. �� d
les attached.
nt Name T )%. %�� LP,✓ Project Location: County, F/j/j,✓swic,C
s `1 /� ;J /'" E'1 CPS �it R L ,4,, o Street Address/ State Road/ Lot #(s)
SOor& o StatP % C ZIP_272,4 V_
#( ) . 624:>>LFax #( )
•izedAgent T"'
d CW EW PTA ES ❑ PTS
OEA HHF I UBA ❑ N/A
1:
PWS: ❑FC:
Subdivision
CityeC P QO,& 4 ZIP 2 7 5
Phone # ( ) River Basin 1-44
Adj. Wtr. BodYC1)w A 01�Z /10/ (nat
yes / no) PNA yes / no Crit.Hab. yes / no Closest Maj. Wtr. Body �/ 'W I—,
of Project/ Activity,y11 i 4'
q (Scale �-
Jock) length V 109ae lu alfM-A
length
lumber
ead/ Riprap length
ivg distance offshore
nax distance offshore
channel
:ubic yards
-amp
ouse/ Boatlift
Bulldozing
line Length eq
not sure yes
ags: not sure yes
orium: n/a yes
s: yes
r Attached: yes
no -
ding permit may be required by: OCP/%., y/SZ P 46P4- 4 El See note on back regarding River Basin
"' ----- -- --'- ----- YL/ ✓ 1 n- . J - 7 L/ /'i - I - . , /i - - - /I C' i

ANTA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue, Governor James H. Gregson, Director Dee Freeman, Secretary
Date I - ZG t o
Name of Property Owner Applying for Permit:
1- N - A IIF.a
Mailing Address:
1461-- We"sTT <� eN'T1Zs1I Ave
Q S k zr oR.o AJ C_. 2 7 Z a Li
I certify that I have authorized (agent) J-c4w W eST-/Wrlsr- DES to act on my
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) 2�-7w// tic-0 L)cc.L
at (my property located at) / o 5 0 (a S B oAt:, -5T"
This certification is valid thru (date) jz-.3c-/b
Vj4'r-' ri rrsIDW"T-
Property Owner Signature
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to T k4 Q d &-x) 1 --C— is
(Name of Property Owner)
property located at # G, o It) S a az0 .s
(Lot, Block, Road, etc.)
on , in 0e-e. ,J I S /P— --W N.C.
(Waterbody) (Town and/or County)
Applicant's phone #: 9io-36 7- 6SS 2 Mailing Address: AU w--cZelff / G//'Z.
01 L3 AC_2153CJ
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)
D t—j 14TT7+CAe a
(Information for Property Owner Applying
for Permit)
/ aJ GILO w.t.J
Mailing Address
(Riparian Property Owner Information)
Signature
O C e 4-oj i S 4 .is' A" &-L

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIER/MOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to .a A! / F-Al / NL . 's
(Name of Property Owner)
property located at g l r>S o302o ST
(Lot, Block, Road, etc.)
on , m oceAA-) I s I E 1i3RtAS(4)(4 , N.C.
(Waterbody) (Town and/or County)
Applicant's phone #:`1/0 3G7-655Z Mailing Address: IS-fS- 644o k) c it a%-Ok-
caceAA) I s /e. is eac-k iJC
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)
=IC157-7i LL 5 V s Te-,vt
(Information for Property Owner Applying
for Permit)
i ,I- 9 S- c ►2-011K-�) c.R.e e- c41eJ
Mailing Address
--------------------------------------------------------
(Riparian Property Owner Information)
G/
zs
Oc a o,&) I S /e Se.4ck AG Z-846 7
%,IiV�CiAtPI%1T
MichAEL ,erc2so,) *teF
71__'- __T_--- _ 1T_

West Docks
910-367-6952
i3t, /Z
8 6, o lAs i3O�to
W • 7-k o v, 'S DAJ

cant: 7
V2 2/ o
Permit #: S t / C/
ribe below the HABITAT disturbances for the application. All values should match the name, and units of measurement
d in your Habitat code sheet.
tat Name
DISTURB TYPE
Choose One
TOTAL Sq. Ft.
(Applied for.
Disturbance total
includes any
anticipated
restoration or
ternimpacts)
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
ternimpacts)
FINAL Feet
(Anticipated final
disturbance.
Excludes any
restoration and/o
temp impact
amount
/
✓/"
Dredge ❑ Fill ❑ Both ❑ Other
L/
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 0 Both ❑ Other ❑

21638
JOHN R. WEST
FIRST BANK
BA WEST DOCKS
OCEAN ISLE BEACH, NORTH CAROLINA 28469
CROWN CREEK CIRCLE SW 66-456-531 j4 - L) - lb
:AN ISLE BEACH, NC 28469
[phone]
W-20$ Z�-
L
O cl /i v'� DOLLARS
8
AUTHORIZED SIGNATURE
1000 2 16 313"m i:0 5 3 10 L 568ll: 7 9 100 1 38811■