28306D - Daniel

CAMA and DREDGE AND FILL
G E N E R A L 283O6-�
PERMIT pioIotee
as authorized by the State of North Carolina -----
• Department of Environment and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC 944 ,. 1 Z.U' .
J
Applicant Name \ (\n .(\ - '‘ C Phone Number
Address 3I2- lu,n c (.:rY1 D( ' r="e-#
City lk k State MCI) Zip Q` 9 09
Project Location (County, State Road, Water Body, etc.) Df u 115Lu'tcK- eou....,,„4-1 t 627
D`r\utie - ch . ZGI)
Type of Project Activity IQC'A/J ` IC-(' l `r`J d c c k-' C ()P'-f-4 t A (11 <^U 'A'``d)
kx(‘-)= .�_ (f) or --(1 n
c d5A .) ne.ecl5 �o dcfc-c� � t�t� � 5e+fr,0 r k-.-
atcof AItJO
PROJECT DESCRIPTION SKETCH i s 15 I ; sat •
+ AC (SCALE: r T )
Pier(dock)Length .31 NOM _
)v' ``,x) x .Lc III
_ a—
Groin Length _ i w 2 V �.vek-
t '� � I
number
1111 - III
NlIl
Bulkhead Length , i,, — lin
max.distance offshore _ INN
IBasin,channel dimensions
i
cubic yards 4 , � Q' . ,
■
Boat ramp dimensions
Other 1 (f) k. Z..) ,1 >.._.... ,1 , 11111 .'r_ ,,,,,,,_E,
( ��'t PS i ,.,� , , 7 . _ , `►)' v._ ._ III
i
This permit is subject to compliance with this application, site drawing i;' ,
and attached general and specific conditions.Any violation of these terms - ` applicant'ssignature
may subject the permittee to a fine, imprisonment or civil action; and 1 ''' ( )
may cause the permit to become null and void. 7 - y
This permit must be on the project site and accessible to the permit of-' I permit officer's signature
ficer when the project is inspected for compliance. The applicant certi-` `l a / i I L i I 115 ) 0 2_fies by signing this permit that 1)this project is consistent with the local ( issuing date expiration date
land use plan and all local ordinances, and 2) a written statement has ,4 1200
been obtained from adjacent riparian landowners certifying that they i4
have no objections to the proposed work. a attachments
In issuing this permit the State of North Carolina certifies that this project 4 I W .
is consistent with the North Carolina Coastal Management Program. application fee

• GEI ERA LTER IT CO] WUTER FORM
rt
ADD1lON L S:
1 DEVELOP -A� ab PRD3 D`SC: p -
_AEC_AECD:SIC: P T �, •VlJ ----
(h�. IA=6 (Will vs3yak=1)
-WORE: R 3)f)L�� E L aO ' X Uo'
(Val ten' t".4)
(vW I ca3y21=:) - .
I LM Ig�J� O(A) 320
(. -s - .
ACTION =IR?TION
DRrTJCr€- P. .QUIP, - 10 1 IS-10 I t ). Js).0 Z`.-
c .soRD ELP Q� )0I (6 / ( IIIsl0 _ .

, e ,otitaer 1-
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
° (FOR A PIER/UNCOVERED BOAT LIFT)
.. '''''; ., I
. i kb y i..i.6irdy. itiii i a'A 06 * ilitigiii W. A-A A fri i Li'd vi I e- /1 'o
(Name of Property-Owner)
'--; .7 ' 91 1 ' N'
otopeny!taw k,, 4. 6 re 1 o e ,r--;I)e kies'i )
(Lot, Block, )koad, etc.)
i
' ,I, . 4,
on i 4 1 P:x e...D ‘s i .. I I,4)2:1-'e-tA)aii 1 ill St-trlSe+ 20 -.)-c.)1 , N.C.
(VVaterbody) (Town and/or Cpunty)
Ne has d6s0rib6d to rile, as shown beldw, the development he is proposing at that
location, and, I have no objections to his proposal. I understand that a pier/uncoyered boat lift
must be set back a minimumdistance of fifteen feet (15!) from my area of riparian access unless
d b iv waey me.
. , ::,„;..i; :,....' . .,:ss. ,,, , -, , ,!, •:. 1:: 'N
'I do not wfsli-tO wave the recOiremeni.
...,::..i,;::.
.;,46 Wioli Id .*Ns4, tli.0 ktick ireqtaiftfrietit,
L
.,...,..,. ... ...„..6 .,i,i, ,..1w.,±;,,.-,r4i_4iAgg4.i.I.,A ;;.i _,d ,,,,,t,-.._.............,,..--....—._.,.--........,..
PEStitIPTION AliD/olt DRAWING OF PROPOSED I)EVELOPKENT:
(To be filled in by inilivicinal proposing development)
1 i
• (___6;IA s-ItelA tiz-i;afri o i„ p ver id--. --: 3 )c4 docK i ous-e r-v t vl
1 5- ton- s e+13 a,L frdivi 4/2 Pi r=e eo ,vnost r i pr i.)in. corr t'cl 0 e
16 ,...........;)0—
i'ft-
' Tt > 7)
tO \:- 3 2, o 0
1 ,
. <-13----)•
1 r
,
r,pr) ; 3 oc."1 V.,-iry Cll
: : . curriClor- i.
• . li'Ae AA •
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7--,,. •
r
Signature
b 0 dc ,t4it . . ,
" ht
Print or Type Name
. , .

ADJACENT ' PROPERTY OWNER STATEMENT
(FOR A PIER/UNCOVERED BOAT LIFT)
herby eatity that 1 own pftVeily adjat ettt to ;_, ii i , ?/ / ►s
(Name of Property Owner)
property to oted at ,Z 3L ore) i e bri've West
(Lot, Block, Road, etc.) II
on i vl`{'ra co as+ ,1 l,�afie r& , in S�vi s e`�'Tezc h , N.C.
(Waterbody) (Town and/or County)
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/uncovered boat lift
must be set back a minimudi distance of fifteen feet (15') from my area of riparian access unless
waived by me.
X I do,not wisi'to waiv ,s tback requirement:
.I rho wish to waive that setback requitement.,
DESCRIPTION AVp/UR DM WING OF PROPOSED ..EVELOPIV NT:
(To be plied in by individual proposing development) •
0in r Ch'On of pIer 1—I Ice dctocK 0eS2ruih
poo± Set :kfs1%rn most r i f ari .)1A cvrrijor ! ).1^4.e ,
Iti 11T�
/O
Corri aor
I �we
Signature
O o W /lii/e//er
Print or Type Name
9�9 s7. 3 21 y
Telephone Number
Date: ?//,2d/0/

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•
CARSON LJACOBS 1111
NCDL 367729 PH.910-842-6978
1200 STANBURY RD SW f 66-112/531
SUPPLY,NC 28462 talc Ct� IS] (0 62101
Tb 6 I $ 2oo.cg-
!o e%€oir/er'
h.urA._red Ytra_"°/tro
BB&T ACCESS
BANKING
• BRANCH BANKINGH TRUST COMPANY
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SUPPLY,,NORTH CAROLINA
.Unto /iwird re w
1:05310112L': 5 195645 2 15u' 1111