76589D - Nicholson

CAMA / ❑ DREDGE & FILL N9 76589 A B I
11
iENERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
zed by the State of North Carolina, Department of Environmental Quality
oastal Resources Commission in an area of environmental concern pursuant to I SA NCAC G 7 H • U aQ71 Rules attached.
/ �/ 9 t
Name (: �'' Je-r i I � f C h 0 I S a e) a �a jt�� 0 Project Location: County '1 Pvt/ �a14�
l JD B�'rnP i+ 1C GGao� 1 Street Address/ State Road/ Lot #(s)
1 /✓p, jl n 1Zn State NG ZIPP4o� S Gc/w`Q-
(?)v 7316 6071 E-Mail Ock twirk,10 CT �' rie Subdivision
ad Agent n1/A City ZIP
(. A,
❑ CW
DEW UKPTA
❑ OEA
❑ HHF ❑ IH
❑ PWS:
;des / no
PNA � ae/ no
❑ ES ❑ PTS
❑ UBA ❑ N/A
' Project/ Activity Trrqr,�4 1 U re bwI
ck) length` W (�L
atform(s)`'2A ), 1?T U12
Platform(s)
ier(s) R L Y 6 ,
:ngth
tuber
d/ Riprap length
g distance offshore
ax distance offshore
hannel
bic yards
mp
ise/ oatl' 14
3ulldozing
ne Length qi (.i, —
not sure yes
wium: n/a yes
yes 0
Attached: yes
Phone # ( —'�"�� River Basin v"'''
Adj. Wtr. Body A/ i'1 W � /r
Closest Maj. Wtr. Body ML/i tk Gee
lV _cc�� li9/rtt� I� sapq-fit I'M
(Scale: I i CC
Ping permit maybe required by: Wo IYl evV �6 Gh
. 1 . 1 Plonnina luricrlirtinnl
See note on back regarding River Basin

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: C' N I CK N I e 14 OLS Gil
Mailing Address: 8 Aj P, -rr �g
nit 1tie, ro,,! &LC�-8yoq
Phone Number: 310
Email Address: _Iy I GK. /J I C�4QLS0l`� t� S�GC ll�B�iL , �J�r
I certify that I have authorized
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: h0CK kf P c6mE4 (-r
at my property located at D 3 u j t I J
in /fit 0PV[2.County.
1 furthermore certify that 1 am authorized to grant, and do in fact grant permission to
Division of Coastal Management staff, the Local Permit Officer and their agents to enter
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property Owner Information:
Signature
- C lC QL Sa�cl
Print or Type Name
Title _

ADJACE T RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to `�ge 1 C 4to z, SOAS I
(Name of Property Owner)
property located at
j (Address, Lot, Block, Road, etc.)
on iITGA�T1 c =. �. l/t( W W. in N.C.
(Waterbody) (CityrTown 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)
To L o GRTt o rJ
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.)
2 'U_ l do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
(Property Ovyner Information) acent Property Owner Information)
Si;- 7� , � , (" �)
nature
g ure l ,
Pent or.r �C
Name nt or me
tSo pe A , , 'G.-c-,-r P W i. t 'Type _.

(Name
Name or Permit Folder
Vendor
Chock Number
Chock
amount
Parmlt Numbw/Comment
Race) t or RHundMoellocated
in3
ip Inc.
3arcia
ipInc
uction, L_LC _
er _
uction, LLC
ColumM _
Echo Farms, LLC _
same
same
CFPUA
Bears Den, LLC
John Keene
Rogetio Drenning Mandiguez
same
Co1umn5
United Bank
Sun7rust
State Employees CU _
United Bank
NAVY Federal CU
BancFirst
NAVY Federal CU
---
Bank of America
Celum"a Co1umn7
2030 $ 200.00
1072. $ 200.00
1441 $ 200.00
4628 $ 400.00
1166 $ 200.00
165480281 S 200M
1168 S 200.00
1787 Z00.00GP
Coombe
Column9
GP #76594D
GP #76541 D
GP #71720D
PA Mt. 10257
PA rctr. 10260
PA rcL 10261
IPArct.10256
JD rot. 10823
_ _
GP#76535D
GP #77823D
GP #71874D
GP#77821D __ _
#76589D
JD ICt. 10848
JD rot. 10822
IPA rcL 10258