Foose, Scott

/ ❑ DREDGE a FILL N9 78971 A B C0 D
E
RAL PERMIT Previous permit #
1Modification ❑Complete Reissue �OPartial Reissue Date previous permit issued
As the Sate of North Carolina. department of Environmental Quality afil�
and the Resources Commission in an area of environmental concern pursuant to I SA NCAC_ V �MAdes at�tarli.
Applicant Name 0 ! t Project Location: County_t-«4�
Address >[F / r 1J.___ r ---- Street Address/ State Road/ Lot #(s) �►'i�
Phone # V E-Mail _
Authorized Agent -__ V-11
Affected Cw ''�A DES O F'TS
AEC(s): 0 GEA ''-i HHF Z) IN 0 URA 0 WA
D PWS:
ORW: yes erf ) PNA (;;)/ no
Type of Project/ Activity
Cubic yards
Boat ramp
Bmdxxse�g�
_ f i
Bewh M
Other
Shoreline Length __ - (- p
SAV: not 0ure yes
Subdivision City--- :7��j ZIP
Phone # { ) River Basin
Adj. wtr. Body -- ipw /unkn) Closest Maj. Wtr. Body
0
j
(Scale:
i }
1
Moratorium: n1a yes�`-
Photos: Yes
Waiver Attar ie& '•:.t rtio +. # L
A building permit may be required by:
back regarding River Basin n
( Note Local Planning jurisdiction))A CA)
Notes/ Specia�l Conditions ~
_ A !'°y. - -f� n ..a '..# }__ ....�. s.,t f s.;". {.?�o i,t. d�;..� # a. ,:.-i,. �"' '- p j.f� :( 'i /V

k1CAMA / ❑ DREDGE & FILLN9 78971 A B D
�ENERAL PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality �� > I,�C
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC '
["ules attached.
Applicant Name �% Project Location: County 0115 0 /
Address r Street Address/ State Road/ Lot #(s) 5a Y I1L
City IZW5 St
Phone # (7) E-Mail
Authorized Agent
❑ CW
_4!(EW
—%aIKTA ❑ ES ❑ PTS
Affected
AEC(s):
❑ OEA
❑ HHF
❑ IH ❑ UBA ❑ N/A
❑ PWS:
ORW:
'
yes 'n
PNA
(P/ no
Type of Project/
Activity
Pier (dock) length r` F
Fixed Platform(s) ' i •i`. — — --� ! i
Floating Platform(s) r
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin. channel
cubic yards /
s
Boat ramp
--
—_.--
... _
........
Boathouse/ Boatl' t J
i.._......._i_.....
Beach Bdlldozing --
Other
I
Shoreline Length Al
SAV: not sure yes no
Moratorium: n/a yes o
....
Photos: yes n
_ ........ ...
Waiver Attached: es > no —'
O0
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions
or ADDlicant Printed Name
S' ature ** Please read compliance statement on back of permit"
plication Fee(s) Check #
Subdivision
City ZIP
Phone # () River. Basin
Adj. Wtr. Bod�a
y n man /unkn
Closest Maj. Wtr. Body � ` v
�1.
I ^_
(Scale: V'LJ (�(�/ )
❑ See note on back regarding River Basin rules.

Name f P open i Owr E r Requesting Permit: 5evrT Z-�do `
Mailing dress: _ j> /Y�j i�i" i
21WF/1"O'Sr r gz t' L /VC- C"e`1&7
Phone I IL irnber:
Email A ss:
i certify tH a I ha aut c rized
Agent / Contractor
to act o beh IF, for t ie purpose of applying for and obtaining all CAMA permits
necess or th oilo i g proposed development- l(' rlC EXi r,
I S f x
� i�a�f lfr-i
at my pi Dperty to ted
in G0/ a
aunty.
l furthe o�a ce i , th � l am authorized to grant, and do in fact grant permission to
Division oast Ma ement staff, the Local Permit Officer and their agents to enter
on the amen . ne Inds in connection with evaluating information related to this
permit a ,60atio
Property wrier Info atio
S atu
CQ
rrnt o ype 9me
i le
t
This cert i tion i alid 11rough F

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PARIAN PROPERTY OWNER STATE
I hereby c ai tifythat wn operty adjacent to E,LS<SC= s
(Name of Property Owner)
property located at / f! 1 �-7-01 �
(Address, Lot, Block, Road, etc.)
on �V L 65E in nlg'AD N.C.
(Wa rbo i (City/Town ind/or County)
The applii e ni has descrit Ed to me, as shown below, the development proposed at the above
ation.
I ha no c b ection to this proposal.
I havP objeP1 ions to this proposal.
ESC I TI JIN AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individu (jp opo g d 4,elopment must fill in description below or attach a site drawing)
1. Extq'nd
exisi
rig wz
Ikway (pier) by 10' feet.
2. RE
rrllove an
epla
existing 17'x5' wood gangway with 16'x5' aluminum gangway.
3. M
\e Iexisti
floa
ihi g dock 10' away from shoreline.
4. R
owe an
rep
fe four existing 4" galvanized steel posts, securing the dock's
p
ti n, wit i
two
pressure treated wood pilings.
5. In
.t II four 1
" prelure
treaded wood pilings to support new boat lift to be placed along
th
rth Si(of
t
e dock. Pilings centers will be placed 12'6" apart measuring from the
ce
iters acr(
es thE
i
beam and measuring from the outside edges along the beam.
I
WAIVER SECTION
I understand
that a
ier,
ock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum
ds
anc
of 15' from my area of riparian access unless waived by me. (If you
wish to waive
the s
bach�
you must initial the appropriate blank below.)
—;
I do wish
to
aive the 15' setback requirement.
I do FrL
wis
`to waive the 15' setback requirement.
(Property
ner I
orm
ion) (Ad' nt Property Owner Information)
l
�(
Signaturej
Sagn ture
— PAVI 5 Sri Lvr tfi d'�
Print or Type Name
h3to M;I1J� cT
Mailing Address
��/� 7) f`I r-, A4 SG
City/State/Zip
c%ltn S'3S-3lTele
Telephone Number
o
Print or T
11
ame4
IL-T
C
Mailing A
ESNC
;dW
City/State
!7
h n
r l
l/l5)X(7Z0
Date
Date
(Revised 611812012)

AD11ACENt RIPARIAN PROPERTY OWNER STATEMENT
I hereby cei ti y that I n p perty adjacent to cSGbTT'p�� s
(Name of Property Owner)
property to a e at 7J- � Al G7/
(Address, Lot, Block, Road, etc.)
on E'�in ,��/�1��i�5 ER2G% N C
(Wat od (City/Town andlo County)
The applic
as d(
ScribE
d to me, as shown below, the development proposed at the above
loc too
�( JkI
have
o Ot
E ction to this proposal.
hav
bjec
i Tns to this proposal.
SCRI
DTIONANDIOR
DRAWING OF PROPOSED DEVELOPMENT
(lndividua r posi
development
must fill in description below or attach a site drawing)
1. Ex t d existii
ig wal
o vay (pier) by 10' feet.
2. Removand
eplac
=1 existing 17'x5' wood gangway with 16'x5' aluminum gangway.
3. Mo xistin
loati
dock 10' away from shoreline.
4. Re ve and
pla
four existing 4" galvanized steel posts, securing the dock's
position, with
�
5. InstEall four 1
t o 1
" pre
' ! pressure treated wood pilings.
re treaded wood pilings to support new boat lift to be placed along
the;nrth sid
f th
dock. Pilings centers will be placed 12'6" apart measuring from the
centers acro
sthe
eam and measuring from the outside edges along the beam.
i
WAIVER SECTION
I understa tat a
i r, d
ck, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a mill,irjntpm di
ance
of 15' from my area of riparian access unless waived by me. (if you
wish to waive the seft
ack,4you
must initial the appropriate blank below.)
I'do wi$
to
wive the 15' setback requirement.
I do n
t wis
t' waive the 15' setback requirement.
(Property vy
ner 1
rm
on) (Adiacent Property Owner Information)
/ , I AXI� P
Srgna i jre
Si aiu �e 11'-1 e- /
� �
405,
zs �tjwl�
GC.-t. ` v \ � t V' 1
Pgnt or Type NaWq
Print or Ty e' Name
I 1
'
T
_ 0!9- b
Mailing Ad r iss
iling Address/ ; b W/0
Cit /State/Zi
(��) Iy
City/State iA
L1
Teleph ne umber
telephone Number
Date
Date
(Revised 6/1 S/2012)