Parks, Clinton 78833C

CAMA 1 DREDGE &FILL ' 3 A B r D
ENERAL PERMIT Previous permit # "=J`
New ❑Modification ❑Complete Reissue ❑ Partial Reissue Date previous permit issued
As authorized by the State of North Carolina, Department of Environmental Quality 4
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC/11 r E
lRules attached.
Applicant Name I i Il Project Location: County o't LTV
Address Street Address/ State Road/ Lot #(s)
City 67L State_ IP
Phone # (}� E-Maif Subdivision t �/
Authorized Agent r- City ZIP
Affected ", A [I ES El PTS
AEC(s):
❑ OEA HHF ❑ IH ❑ UBA ❑ N/A
❑ PWS:
QRW: yes /J`no) PNA /yes / no
Type of Project/ Activity C
Pier (dock) length
Fixed Platform(s) —
Floating Platform(s)
Finger piers)
Groin length
number
Bulkhead/ Ripraplength
avg distance offshore /
max distance offshore
Basin, channel ^'
cubic yards
Boat ramp
Boathous oatl ft'
Beach Bull d zing
Other r4
Shoreline Length - �9_
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Waiver Attached: ( no
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions r l
► Phone # O River Basin .,
Adj. Wtr. Body n /man /unkn
Closest Maj. Wtr. Body ❑ t1
�r % x
(Scale: I ' 1 f
❑ See note on back regarding River Basin rules.
Cate

jk2�A / ❑ DREDGE & FILL )� c N9 78833 A B 0 D
ERAL PERMIT Previous permit#
New ❑Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued
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 ( f'I ! y
t _XRules attached.
Applicant Name_ I t Anxi- �,S Project Location: County nn SdaW
Address 4- Street Address/ State Road/ Lot #(s) :En �
City lam. /�� State��ZIP%
Phone # (t ),5#5- 5579 E-Mail Subdivision , 1 0 1" y
Authorized Agent 11
Affected ❑ CW �A
AEC(s): ElOEA HHF oiH
❑ PINS:
ORW: yes ' no PNA yes / no
Type of Project/ Activity 0G
Pier (dock) length
Fixed Platform(s) a
Floating Platform(s)
Finger pier(s)_�
Groin length
number
Bulkhead/ Riprap length_
avg distance offshore
max distance offshore
Basin, channel
cubic
Boat ramp
Beach Bulld zing
Other
Shoreline Length h ()
SAV: not sure yes
Moratorium: n/a yes
Photos: yes
Waiver Attached: (9 no
A building permit may be required by:
( Note Local Planning jurisdiction)
Notes/ Special Conditions JhVl
City ZIP /�
❑ES ❑PTS Phone# O River BasinV1�
❑ USA ❑ N/A Adj. Wtr. Body `i n man unkn
Closest Maj. Wtr. Body
0i�i�gS
!Agent or I' noted Name
Ana a **Ale a read compliance statement on back of permit**
'. 1810
Application Feels) Check #
(Scale: � 0 " )
❑ See note on back regarding River Basin rules.
Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 01 AJ �U�kS /l _or-)N�ja irk'1
Mailing Address: 1 H7
s�V,,�oNudl l ► o-. zSSyo
Phone Number:
Rice- Sws-sic
Email Address: P� c -V.P eQ �f-• Cbw1
I certify that I have authorized xk) -) r
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located at
in County.
l furthermore certify that I 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:
`'G�Gf 9 Si nature
LI'tiloN A uks 009(A(Ill, tied
Print or Type Name
Title
l / 12- / 2A
Date
This certification is valid through I /,
RFCEIVED
JAN 2 0 2�2I
DCM_MHD CITY

ADJACENT RIPARIAN PRQP }}R11TY {?4VNER/TATEMEN
I hereby certify that I own property adjacent to i..if U ¢ffA ( :i51r/ urr r.
Property located at
M
a
of Property
N.C.
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 ANCHOR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must tilt in description below sr attach a site drawing)
W IVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
T(Property Ownar formation)��
r> (Adjagent Property Owner Information,
is 1,117 , n I1 r ar_.. _
N
"Valid for one calendar year after signature*
(Revised Aug. 2414)

5)touer
b�
_7
111

I hereby certify that I own property adjacent toltifl,fu4 t"rf„___'s
{ is of Property Owner)
property located at ,
{%tJ tr ddress, Lot, Ioc , Road, etc.
on {b�4 { i in N.C.
(City/Town and/or County)
The appli ant has described to me, as shown below, the development proposed at the above
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(individual proposing development must rill in description below or attach a site drawing)
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 16' from my area of riparian access unless waived by
me, (I you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 16 setback requirement.
it n
1 do not wish to waive the 15' setback requirement.
uata
I
*Valid for one calendar year after signature*
Sig a Ul. C
Print grTNameY
-YsAr
Mai A r tr
fcrs
,S3�t
Tellaapehio� ber/emal/address
Date* `—
(Rovised Aug. 2014)