54086D - Chambers

F,'CAMA / ❑ DREDGE & FILL 5
GENERAL PERMIT Previous permit#
FWNew —Modification El Complete Reissue El Partial Reissue Date previous permit issued
orized 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 r 12-Uo
� ,n [L}Ru'les attached.
Lnt Name :� CA, ( � 49x" � ^c 1 Project Location: County 34C id & C
,s C. // / FO `�-q d-i, de Lt%.4, ✓e% � 5,,v Street Address/ State Road/ Lot #(s) .5f�.V f
A4 & 7� State ZI P ,2
ized Agent 436't'v PnJ
❑ CW W PTA -,ES C PTS
❑ OEA ❑ HHF -! IH ] UBA ❑ N/A
PWS: ❑ FC:
yes / ib PNA yes;/ no Crit.Hab. yes / no
Subdivision1,7�1L'e C1e71le oz)a"'t
City 4110-71� Q ZIP- 2 P
Phone # ( ) / River Basin ZCe
Adj. Wtr. Bodyt 1-# J e S11 &7j., C 'At nat
Closest Maj. Wtr. Body/ Lr/ �✓
of Project/ Activity Re m6 ✓ t Ex 1-s i 17a, a 4 -e y' p /L `� r� s "�O L ( � � r•I (I i F>2
/� (Scale:/
lock) length
-m(s) °e-" Uo�'d
L 'a
length
iumber
gad/ Riprap length
wg distance offshore
nax distance offshore
channel
+
:ubic yards
amp
--
:)use/ Boatlift
Bulldozing
v
i
ine Length Q y .
not sure yesCpp-,.,-'-�
igs: not sure yes Q,-
arium: n/a yes (3FpL
yes ILV�
Attached: yes Crt6 ,
t.
' vt
ling permit may be required by: C eU
❑ See note on back regarding River Basin
// ., /, /. .. I -. n

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
hael F. Easley, Govemor James H. Gregson, Director
Authorized Agent Ponsent Agreement
Hlabc. Lflou-�`6e,
(Printed Name of Agent)
der to obtain any CAMA permit(s) required fop
;ific activities described in the attached sketch.
—:ATION OF -•
►PERTY OWNER MAILING ADDRESS:. .
p
PHONE NO.' P1
HORIZED AGENT MAILING ADDRESS:
William G. Ross Jr., S
is hereby authorized to act on my b&
property listed below. The authorization is limited tc
PHONE NO. 010 `— � S `1 ' 102 7
ature of Property Owner. Lk

T—i
_70i
4mk
To
IV.
us[ ry
�b
=!Tt
twv I
OL SurfJ3
oil TYTFTT)
Ua
t
RD

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(FOR A PIERIMOORING PILINGSBOATLIFTBOATHOUSE)
I hereby certify that I own property adjacent to J's
(Name of Property Owner)
property located at
(Lot, Block, Road, et94
on in in 4 , N.C.
(Waterbody) (Town and/or CountV
/o-7.S3-239Z
Applicant's phone #: � Mailing Address:
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 (Riparian Property Owner Information)
for Permit)
n
Mailing Address Signature

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
(TOR A PIER/MOORING PILCNGSIBOATLIFTIBOATHOUSE)
I hereby certify that I own property adjacent toga ck F% "L,- C�Arn 's
(Name of Property Owner)
property located at / ~% In, 0 C6d &J i C. k Lad i AJQ ✓lY j ysZ Ida f
(Lot, Block, Road, etc.)
on 61AI1.0-t c riyc-a_, in IS31 j2AlS0iCI(- rouAu�` V ,N.C.
(Waterbody) (Town and/or County) 1
Applicant's phone #: 1Zd-'755-23RMailing Address:PNO CAAAkii'cK k"*7)Z 5. u
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 (Riparian Property Owner Information)
for Permit)
178() C wiLR LQNQi/1 _Tr 5 .ki (�/ �,.L`,
Mailing Address �� T n Signature

ATLANTIC MARINE CONSTRUCTION
P O Box 713
Shallotte, NC 28459
Ph 910-754-4247
DATE
OF
DOLLARS �
cm
BRANCH BANKING AND TRUST COMPANY
1-lW-BANK BBT BBT., �p540R(o
FOR ,^ r� I {
v� Q 1� i ii/�ti�?%J
1180000 1499ii' ':0 S 3 10 1 1 2 1':000 S 29 S0008 311-