77280_Cody Woolard_20200921

0 L?CAMA/ O DREDGE & FILL # (0 0 1 Uq a
NERAL PERMIT • 77280
Previous permit# 1,il
> - New ❑Modification OComplete Reissue ❑Partial Reissueir
Date previous permit issued N Jn
As authorized by the State of North Carolina,Department of Environmental Quality r
and the Coastal Resources Commission in an area of environmental concern pursuant to I5A NCAC 4"f . 2,000
Applicant Name C OyL ¢D es attached.
Project Location: Countyew
Address /I)O Si rAMCIA 5 Leine Street Address/State Road/Lot#(s)
City u1Csili 11, bn State 1\)C ZIP 238.841 Fl2S4 / rPo5a S t rei �Zc�
Phone#(267-)Qy _7510 E-Mail Subdivision m I vt(1054 51,0rt5
Authorized Agent TT , city UUASLify 'D/�
��C7��[' IflQ ��o ZIP ,245Q41
Affected
0 OEA 0 HHF 0 IH 0 UBA ❑N/A
CW PTA ❑ES OPTS
AEC(s):
Phone# (L5L)Na,- 'IloSIrS River Basin�-�'�/p roi
Adj.Wtr. Body}Lo R.{k tv-. /unkn)
Closest Maj.Wtr.Body 'PAWN 1I Gb R-i e1•
ORW: yes ,€) PNA yes /C)
Type of Project/Activity Replace. exl5iiiy fyS"xlp/ pier . Pt.iry.a ,b retletK /s'X 11
tekhOctkk uoeiJte be: -1114mq roof as wet( ar ,!o'X 4/1 Ca&w41k
Pier(dock)length T 1 NS''7%(o' _ (Scale:
Fbced Platform(s) ,--- `,- I --_
Hosting P�orm(s) I --11--- - _.. •• -•-- -.. ° { - f 1 : ;
Groin length } s 6 C 1- /.. _ 1- ---i 4-- + -- --j • 1�1- ' - - _I
number � i --- -I _ � - ,��L � r _ � � _` `_
__
10�
Bulkhead!Riprap length - j .. y-r _._ _.� �, - -- -
1� gy�pp__ l I
avg distance offshore T I t ___ i
max distance offshore
!_. _ _ �_
Bash channel j ? .1.. ._.
- 11
4- y�-. 1-- - -- l . . I _ i i I _
1.
cubic yards X15 Je `� _... _
Boat ramp ,. t ,, ' ILft , . { -14
'�- --_
Boathouse/Boadlft `� , ,
I ,_ ,___ i i i ._
_l_i_l_ .__, _ _i_ - -_. .
i_
1
L.i-. i_ ._ _ t1.fK_At., 1 ;.____________ __. „ : J,,,,,.
Beach Bulldozing - - f --� �,,�p�� - 1i ,
Other __, i _ �, 1 ,_ -.. ..� t , , 5, ...._ .._
(rit
i __ t_ _ — . 11 —I- __i-
_ - ____ - -
} .�_ _1 I
Shoreline Length- /05 { . �•' ;
SAV: not sure yes no (�, ,J + 1 i__i.A _ ' �.- —
/ . --- f, I
1..
Moratorium. n/a yes � - ->r - - -- P Jt`� I t — - -.
Photos: s t +' tei.
Waiver Attached: Cep g, i • • fill_ i_--.__
ti
II
A building permit may be required by: teA ,-•k- Co •
(Note Local Planning jurisdiction) See note on back regarding River Basin rules.
Notes/Special Conditions RpQjjCarl f f t ire plc*c;, D i-i. S.)< .-1-.0);�„,s,1. # / S C 4)eic�
/hair/ eXcr# per 14(✓I�G- 1 5 1q fl/S, c-ajo (� Ca)
.rlS+od( T 4frI Dh i ,
nt or AgeAp Printed Na
�G� pfUg t�l
C--,
Per Ito 's Prin ed Name
Signature "Please read complia atement on back of permit' I at `
pc1 4 2.O v = 13 3c7 g
Application Fee(s) Check# Issuing Date U'1-v 2 f Z.d 7-
Expiration bate

OF CAMA / il DREDGE & FILL N° 77280 P C D
9ENERAL PERMIT� w ilModification ❑Complete Reissue ❑Partial Reissue Previous permit# N1>Date previous permit issued N Ift
As authorized by the State of North Carolina, Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC N • 1-Dc .Vlk
pn
ules attached.
Applicant Name CO DY I,.00L.4117 Project Location: County 3�tA-ko rk
Address /00 BSI rr Y ' s Lane Street Address/State Road/Lot#(s)
City I�l)a511.1 n1�a'1 State tC ZIP 24-stcl Sascr in;0105 t Si ores R�
Phone#(2.52.)Ry,'1570 E-Mail Subdivision '1Y1 1 vyluS<, S1kortS
Authorized Agent TS' a c r . _NtA--o City 1,00►411091a11 ZIP vZ7ggei
Affected ❑CW N W /PTA DES ❑PTS Phone# (t5Z-)moo- y65-C River Basin -1-4£./ 74tyl
❑OEA ❑HHF ❑IH ❑UBA ❑N/A �l�,� an /unkn)
AEC(s): Adj.Wtr. Body c ru.l i Lv
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body L TY II C.t Blurts
Type
of Project/Activity R epl tce ni 15C 1 V CJ -t/YS 'x l; p ex . 17uirpt se ib r1Fk1 .e- )S'X y
LAfu-kAk xie .( btex-RIo+.trC Tool A5 Wet( et A,ix cid tak,tik (Scale: r - If D )
Pier(dock)length ! I L -A i
Fixed Platform(s) - -
Floating Platforms) �S� 5 ;C b '
Finger ier s x
Groin length ( \D5' I ; I
number
• S 1
Bulkhead/Riprap length - 11111111110111
y4D < _. _-
avg distance offshore 1 ' 1 ' I
max distance offshore 1—\II _ 1 ! ' II
Basin,channel ! IS I I ±
cubic yards 1
Boat ramp • S 1x1QAIL `S T { ' , j
Boathouse/Boatlift —__._.... ec LL- .. _....._.... ............. _._.___._......._-_._._._. _.._.__............._....... ._ _. _.
1 1
i
Beach Bulldozing ' ' f 4 I :
r CA5i ' i;r11.11111
Other I 6
11 II_ i y'. I Alv�� ? _
Shoreline Length - /05 _ �J ' ; N
1 , ti p
SAY: not sure yes no .- 1) \I p4 , -- / $�Y!`41"
Moratorium: n/a yes ©o I T.
Photos: yes Oo _. _ . .._.._ _
�e�., - I T f
•
Waiver Attached: es l9' : I i
L IL
A building permit may be required by: tet.WSti/-k" l.0 - . V<ee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions Rp Iicak,V 1 i repL 0 �••1 S bcx. � '5< �'j i•-)5, s i s C(-'hslde,C�
.:Pair/ t (crt*q r -ref 14I 15 p pis, o3,10 (.))Ca
I4-cam '5pr0GLI
Agent or Applicant Printed Name Per itO cer's Prin ed Name
Signature **Please read compliance statement on back of permit** ig at
ic,c°di 4 20 d;1-52- 13 -7 36 2/ Saar, 2c)2v 7 f ., - -
Application Fee(s) Check# Issuing Date Expiration Date

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action;and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(910-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden, Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

SLCAMA/ ❑DREDGE & FILL N° 77280 A 0 C D
CIENERAL PERMIT S t-\ i ' tr' 1 (4' f Previous permit# 1314
>� 7,New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued 0 IA
As authorized by the State of North Carolina,Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC N . 2.000 .
Jules attached.
Applicant Name Copy 160/%44 itD Project Location: County e7a�ki=or-'f
Address lC D S womb!,S Lane Street Address/State Road/Lot#(s)
City 0361,l©q State ?,C ZIP 21 9 <5.0 /)1,mos-. S}wrif R�
Phone# 2�2' ' ' - (� E-MailSubdivision Y' 'I v a c,re
( a 9 1 �Yl S S S
Authorized Agent '( [,� qY\p rye (nr, ` City Wok ZIP �3cg9
Affected ❑CW 4w VPTA ❑ES ❑PTS Phone# ('5L )got,- `K S 0 River Basin -rA / tv,
❑OEA ❑HHF ❑IH ❑URA ❑N/A
AEC(s): Adj.Wtr. Body Fe,n.,y'co Z 1 OA c ,f'iat4man /unkn)
❑ PWS:
ORW: yes /Co PNA yes / n�o Closest Maj.Wtr. Body ?IIrr'\l cc: a.t v Y r
i
Type of Project/Activity .e 0,,ce ex14}-1 v►j /4.1S x 10/ -p/e r , Fiav pc.se -err ctiL,ce J S i x Li1
NilrJr, k u e_r br,.40,Are rp0T i S wel l Q.r GI3/)c 7 / Co1-,,,.l k-- (Scale: _ Ito' )
Pier(dock)length t I t-/K- (:„„/ ll
Fixed Platform(s) 1 I i
Floating Platform(s) S j s ‘
Finger pier(s)1d `I' / rip
I
of / Cj7l Y rt r . , iIIU
. 1111 �1 .Groin length
number _ 1, ._.Bulkhead/Ri ra length �m _ ' O I ■■■■,
Rip rap u
avg distance offshore ! ■■ I�� ` ■a. ' ■ .am 1ghiliuil■■■■�■�
max distance offshore
i
Basin,channel F I
cubic yards ■■aram t■I®mi�iir•� i ■■■■■■■
Boat ramp -r 0 .� pill
7 Boathouse/Boatlift ; t � '1;;1, , ,r ni„. i ■ . i
Beach Bulldozing 1 ! ' ■111110. �_, --43- - ■■■ ,`` .MAM■■ ■■■
Other hihhhIIHE —+ IIII ' gt C ■hh■ ■�
1 1 1 i HhlhlIlIhhI ■■1111 " ■■■■■■■■■■
! .___! i r rr�_IH1■ . m■I■■■.�■■■■■■■■■
Shoreline Length :+ i 05 , - -SAV: not sure yes CC,,i , ' 1m� -. . .��■■� - - ■-- — Aj1.! �■�� 1 _1
\�-//
■
Moratorium: n/a yes —I Vet„1I s ' : , 1 '_c,,may
Photos: yes Q i a--^ I I
}
Waiver Attached: e no 11 ,
,/
A building permit may be required by: eaL. r-tr Cp . . LIQSee note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions p'Pj,,,arr , t ,vc,1�.,,s) € }mac,.- i-).-„,, ,J ,-, r ♦ , c ,y„)„,, "-,
/-k c.iCl/ fxer,--qii Tele qCIv— i rJ f; c- ";-. . G?►o C7�
Agent or Applicant Printed Name Permit is Printed Name
Signature **Please read compliance statement on back of permit** ig at
t
,_ --(c)1c 4 2v o--J i 5 `7 3) -_/ ___) .I c) -_- , -' '1 i -1- b
Application Fee(s) Check# Issuing Date _ Expiration ate

Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-72 1 5)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-648 I
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

--: r -..- ,
OF❑CAMA/ ❑DREDGE & FILL NO 77280 A BCD
q.EN PERMIT Previous permit#
)—% ElerNew ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued ';'�
As authorized by the State of North Carolina,Department of Environmental Quality ff''
and the Coastal Resources Commission in an area of environmental concern pursuant to I SA NCAC H . )-D •
ckRules attached.
Applicant Name C c vy OODL A Q p Project Location: County { LA.'<
Address /(j 0 S I m r11 GI.1 S i_a Y\t' Street Address/State Road/Lot#(s)
City _j)*S)',, 11P4 State 1,jC ZIP gss9 'ij,411r4, -))1 -ef gU
Phone#( ) /:7!J- Y ' E-Mail Subdivision Y'(\ , ,'y1._S. Sic(. ,
Authorized Agent '-5'e, Y1`\V1-tr'. tiart'i . City l(}L1 c4'9,^y}t,f') ZIP .)7(C`9
Affected ❑CW ❑EW [4TA ❑ES ❑PTS Phone# ( )'!CC,- `l(G S t? River Basin 'TA 7,�PA An
❑OEA ❑HHF ❑IH ❑UBA ❑WA
AEC(s): Adj.Wtr. Body 7,r'-‘,c G itt v a ( (nat /man /unkn)
❑ PWS:
ORW: yes / no PNA yes / no Closest Maj.Wtr. Body 6 YY" 11 c-r, t i Q):,'
Type of Project/Activity ,,,. , t ,c e "x tc 4.1 el, t iy<• X 1%f I. t c..,f 0,$4 - `filet c e i S d x .
- 4.; .V. .J.ti'1u e t bc„a i'i w.ve i*,:,,D k ti s w e i I Ct f ‘(u i 'y u i-+[,A 11C (Scale: ) _ lc; )
Pier(dock)length t J -/<T Lf
IFixed Platforms) { 3�I s Floating Platform(s) SI 1(nFiner ier s !/ ' _ r• �- �*
g P O.,:Y 1 1 1 .i t !I4......14........#:,,,
�
1111
Groin length y C ,0 U p i
number .._-..._.. I. i-iIC� y - r --
Bulkhead/Riprap length . 1 4 1.... .-.4 • r !0. N4 --
avg distance offshore fic i' S
I I I ; \i . I 1 : ..
max distance offshore i H
Basin,channel f {
/ ir�Cir;t�t. _ Ii ' tt _a
cubic yards / t'X1S -C { „_+.� \ + I' iG �� ���%_ ` 1
Boat ramp f l,L �t(fi 't N S T ! 1
Boathouse/Boatlift —i- ,.#-� __(�4���� t-,,.ifsr t 1 �����77'''"''"```'''" 1- l.._ T __ ...__.__...__—
�._..._..-_-...._.ii ! __ i -- `f
4�
Beach Bulldozing j I • (` �' y�} 471
Other i l b��A 9I� I l r R
Gi -�G
J
t
4
Shoreline Length t !y *u j f i j'�� i
SAV: not sure Yes ��� ) + --- H 1- 41.4
Moratorium: n/a yes
Photos: yes 0 _ .... ! ' '
Waiver Attached: e., no ' --���// '
A building permit may be required by: ?....,e",.,,,,,--C C. . . R2' e note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions 04 1,(.,,„r I t r.,i,Jui,-,� s }„Y_rh,,..ci i,,j. ,,J c -t !::,,544)4- .--.)
4 --r+f7: r Nrry-T.1 -1--1. 11CA Ic' N f. 1S c)tD !. 1' ,'
/
I.,
.
Agent or Applicant Printed Name PerrmitOffic`er's Printed Name
1.
Signature **Please read compliance statement on back of permit** ,Signature
t
Application Fee(s) Check# Issuing Date Expiration Date

I
Statement of Compliance and Consistency
This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any
violation of these terms may subject the permittee to a fine or criminal or civil action;and may cause the permit to become
null and void.
This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The
applicant certifies by signing this permit that I)prior to undertaking any activities authorized by this permit,the applicant will
confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local
ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian
landowner(s).
The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
information and belief,certify that this project is consistent with the North Carolina Coastal Management Program.
River Basin Rules Applicable To Your Project:
Tar-Pamlico River Basin Buffer Rules Other:
Neuse River Basin Buffer Rules
If indicated on front of permit,your project is subject to the Environmental Management Commission's Buffer Rules for the
River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of
Water Resources. Contact the Division of Water Resources at the Washington Regional Office (252-946-6481) or the
Wilmington Regional Office(9 I 0-796-72 15)for more information on how to comply with these buffer rules.
Division of Coastal Management Offices
Morehead City Headquarters Washington District
400 Commerce Ave 943 Washington Square Mall
Morehead City, NC 28557 Washington, NC 27889
252-808-2808/ I-888-4RCOAST 252-946-6481
Fax: [phone] Fax: [phone]
(Serves:Carteret,Craven,Onslow- (Serves: Beaufort, Bertie, Hertford, Hyde,
North of New River Inlet-and Pamlico Tyrrell and Washington Counties)
Counties)
Elizabeth City District Wilmington District
401 S. Griffin St. 127 Cardinal Drive Ext.
Ste. 300 Wilmington, NC 28405-3845
Elizabeth City, NC 27909 910-796-7215
252-264-3901 Fax: [phone]
Fax: [phone] (Serves: Brunswick, New Hanover,
(Serves:Camden,Chowan,Currituck, Onslow-South of New River Inlet-
Dare,Gates, Pasquotank and Perquimans and Pender Counties)
Counties)
http://portal.ncdenr.org/web/cm/dcm-home
Revised 7/06/17

f
Authorized Agent Consent Agreement
r
1
g' ( p' t /41,_,,, 4 ,herb
Property owner(s)) y authorize Tobin Jay Tetterton of
TJ's Marine Construction,LLC to act on my behalf in obtaining CAMA permits for
the location listed below.
PROPERTY ADDRESS: /f ,�
__FOel 4r„-�Us,q 5 ore.5 1CC74
PROPERTY OWNER'S MAILING ADDRESS:
_.S�o di Ltia /a r
JD ' S I,ry, o nib GA n(-&---
Phone No. 2 c Z- c'9 7c70')
Si
PROPERTY OWNER'S SIGNATURE: (:)0,9i, //di oa-,.
AUTHORIZED AGENT'SIGNATURE;, �� ,�J
TOBIN TETTE ON
DATE:l/i 20__
W/Authorized Agent Consent Agree.
1

r
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to LQi\ t f Vt.jl v -S 's
(ttanra of Property Ow�{e^r)� !
property located at r2j aV( N\k' O Lc1 ,S - c S. O..4\ i, tt�l TO C
® � (Address, Lot, Rlo k, R d, etc.) q .!
on ro \C0 C"�`�Kp , in V ti� /1l� tyl , N.C.
(Waterbody) (City/Town a�d/or County)
f,
r,
The applicant has described to me, as shown below, the development proposed at the above
locatigfl.
kdJacerr !/ I have no objection to this proposal. r
Froperr/ I`
Owner I have objections to this proposal. t
check ores
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must fill in description below or attach a site drawing) f,
1
`� , S /�/lA ,
l` 6 D U`f �'�c Ems'
05,
--� z 6ne— Li) f6DO -P7-- 6-:
A ►JQ— /6 tC + 0a &
A
WAIVER SECTION
Prc ; I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
au., must be set back a minimum distance of 15' from my area of riparian access unless waived by
.Mit me. (Ifyou wish to waive the setback, you must initial the appropriate tvai _ blank below.) f
I do wish to waive the '15'setback requirement.
1<`o e Akio
_` ` I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Ow a Information)
,_., di?
Signatur `g s iin .tu;e- ^t` L i l a.snE
Pt or Tye Name P`t or Type Name
`
Wing Address
ljC 5,., : t'o=' Aft X,'1332 lr dr sd NL a.�
City/Sttf ip ✓7 Cit Stete/Zip
- 4, - . Lt> • '7 ,, -a- 7c-1 —S(oo Telephone Datef`� N�Gr/email address Teleph�e1Smbe2r�mail address
Date*
(Revised Aug. 2014)
Valid for one calendar year after signature"
!

F
ADJACENT RIPARIAN PROPERTY OWNER ST TEMENT
I hereby certify that I own property adjacent to -Liwo
o/41 al
property located at ��� k C�q s`,,o,� ,s .
a e of Prroopy rly Ow er)
Y,,,\Ietc.)
S YlQ �� "
on ?OM,C (Address, Lot, Blo k, R J .
in v1
(Waterbody) N.C.
(City/Town a /or County)
- - The applicant has described to me, as shown below, the development proposed at the above
locatign.
1/
k, �,,, I have no objection to this proposal.
d
Property
°t or I have objections to this proposal.
Clieni
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing) ,1
eX iS�;tn / /eI � (6C{ //d .
es 0 bQ r" Z/1-1— . , ,
Rep,C11dr`
..74....__in 5.,.+6 ii 0 I-, e___
ge asc---'---- ,
Adjacent WAIVER SECTION
Property I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
,.r,,,er must be set back a minimum distance of 15'from my area of riparian access unless waived by
"ust me. (If you wish to waive the setback, you must initial the appropriate blank below.)
initial
I do wish to waive the 'IS'setback requirement.
V
v I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Ow r Information)
„ idi/ /-e-"'-` s j110 -atiAitlk—
J jt6 tur � I) �� — /
v o v ` , kiAt) ,. 0 ---,Vigil tt;e"
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l'rigt or T e Name 0 Vnpo )\111 QmS
t or Ty blame
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M,��/'ingAddress Y "`,Mp �n��
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City/Stet ip t 1 St 1�'33 (tJ(� a�
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Telephone Number/email address �a^�( r/ S w03
Cl `r�' /, Teleph e Number/email address
Date / vrf'S '2p
Date''
Valid for one calendar year after signature" (Revised Aug. 2014)
•

i
ADJACENT RIPARIAN PROPERTY OWNER ST ATE IViENT
i
I hereby certify that I own property adjacent to // 1
i / i L'L•JCS /�0J/ 's` ..
located atv `� t me of Prop rt Owner) I
property
2r' ,1 1p• eS /
��'� / ( (Address, Lot, l3 ock, Road, etc.) I
on 6-? ,,,,i ! ` ( c.) o,4{v(f , in , N.C.
( y) (City/Town and/or County) .j
{
The appli ant has described to me, as shown below, the development proposed at the above ;i
locatio
Adjacent I have no objection to this proposal. i
Props ;
Owner I have objections to this proposal.
Check ono
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT 1
(individual proposing development must fill in description below or attach a site drawing) -
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Hd)eceui WAIVER SECTION
Prorerkg I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin Cema3 must be set back a minimum distance of 15' from my area of riparian access unless waived by
mat me. (If you wish to waive the setback, youLmust initial the appropriate blank below.)
;niaai
I do wish to waive the 15'setback requirement. :I
I do not wish to waive the 15'setback requirement.
(Property Owner Information) (Adj nt Pro n lnfor ation)
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Signature*
Pn'at orype Name r Print or Type ame r
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Mailing Address i t d �`f�Ll�7Y? tN��yT
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City' tate/Zi 1 2d ,
2 Z - City/State ip/ J
Telephone Nu ber/email address el h e Nu ber/email address
Date Date
*Valid for one calendar year after signature' (Revised Aug. 2014) 'I

IVC Division of Coastal Mgt. Habitat Impact Computer Sheet
Applicant CAD a, (43ookrY )
•
Date: cj/I /V
General Permit*: 327...vag0
Describe below the HABITAT disturbances for the application. All values should match be game,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft FINAL Sq. Ft. j TOTAL Feet FINAL Feet .
(Applied for. (Anticipatedfinal (Applied for. i,anticipated anal
• DISTURB TYPE ! Disturbance total disturbance Disturbance ! disturbance.
Habitat Name Choose Ore j ncludes any ° Excludes ?ry total includes Excludes any
anticipated restoration any anticipated i restoration and/or
restoration or and/or nip restoration or temp impact
temp impacts) impact am curt) temp impacts) amount)
Dredge❑ FII❑ Both ❑ Other g I z �
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other ❑
1 i �
•
Dredge❑ Fiir❑ Both ❑ Other ❑•
I
Dredge❑ RH❑ Both ❑ Other ❑
Dredge❑ RH 71 Both El Other ❑
I I •i i
Dredge❑ RHO Both ❑ Other ❑
' I
Dredge❑ RH❑ Both ❑ Other
I i
•
l !
i I i
Dredge❑ Fill❑ Both ❑ Other ❑
-r I !
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge 1 Fill❑ Both ❑ Other
` I I
Dredge❑ Fill❑ Both ❑ Other•
❑ i i i
Dredge❑ RH❑ Both ❑ Other ❑