79975D - Jackybeit

vcAmA / DREDGE & FILL Sato No 79975
GENERAL PERMIT Previous permit#Allrge
A B C
>C New El Modification Complete Reissue ._i 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 I5A NCAC © . Z
(- ' ❑R es attached.
Applicant/Name `(( r /0.6.)64-`. L�`�(c'MVO Project Location: County � rh„C`r
Address LIZ5 141 \eLQQQ Street Address/State Road/Lot#(s) Z(tsf 2,j1 - lewood
City bOil(kACK9dYk State {I,LZIP ZgL{Qq
Phone#(T0 )7LZ-423`8 E-Mail Subdivision ,✓) //t� R 1 QQ
Authorized Agent 'QL vLfi � t\r-i r5 . /JL City W' CC r.kov,- SeozI1 ZIP 2.54Z��TJ
❑CW NifEW &PTA ❑ES ❑PTS Phone# ( ) River Basin C--Fg
Affected ❑OEA ❑HHF ❑IH ❑UBA ❑N/A r-_' -_ ��^ ' n
AEC(s): Adj.Wtr. Body ( 6. 6 G (nat / an /unkr
❑PWS:
ORW: yes /� PNA yes / no Closest Maj.Wtr. Body �kfi f I �
Type of Project/Activity C A'C32, S iRc c K dcx_k_ d o
r�
�` `� (Scale: I ; Cv )
Pier(dock)length`....,..,....,.
Fixed Platform(s) �� f — —` I I I
Floating Platform(s) X` 1. j j j
nger pier(s) (Pkifkida
G in lengthI 4
i
i { i
umber —. i
Bulkhe.d/Riprap length I ------ --i-._...----._..... _
avg.istance offshore l[V
max.'stance offshore
i {
k
Basin,chann i
i f i
cubic yards I
Boat ramp
i { i
Boathouse/Boatlift — ` -i i
Beach Bulldozing — r i
Other
e34tV6) i
.
Shoreline Length . I 1
SAV: not sure yes `/�I� ___ f _ '
_�,p�
Moratorium: n/a yes gt L it i
i
Photos: yes i ! : 1¢4;� 7 i '1�C� a
Waiver Attached: no ,
A building permit may be required by: Cf'frot rh-Ck- C-FeSD•C` \ . 1 See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction) 1 �, L
Notes/S ecial Conditions S OU`�� ba cIJ\\{ fah 4Q,.i3
R .• ,Prt1 Ci4i1 iZ 'TO K/ . S'ketZ r 4--
„i____ . eiZ• "tfq--r(d&ttP i--"v‘ 1.1-
nt or Applicant Printed Name v Permit Office ' int ame
TN/
Signature **Please read compliance statement on back of permit** Signature. i Al A

0 CAMA / ❑DREDGE & FILL ` it..- a k ck-- No 79975
ENERAL PERMIT Previous permit# A B C
��-= KNew ❑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 I 5A NCAC �J -t"N , Z -'
ElL
f- /
Applicant Name41(r L Ru es attached.
IC.0 4" , MikC_koy Project Location: County i.�'• w rp„G`r
�
Address ,.`. - 1-1cL t Qv.. \la- .' ak . Street Address/State Road/Lot#(s) z j5/2« -c4k(A70a
City LA3 iTc Y\ State --,)(_,ZIP Z t{C`-A
Phone#(''/( )76,Z- 2 E-Mail Subdivision 31t01ssice. C Ps`-‘t�D
Authorized Agent C- -1, Rk.it hie...• City Car-ON,. `z•t ZIP ZByz`'c
Affected ❑CW 'SEW 'PTA ❑ES ❑PTS Phone# ( ) River Basin r
❑OEA ❑HHF ❑IH ❑UBA ❑WA
AEC s : Adj.Wtr. Body —R�^- �J`` (bA\1 (th �--(nat / n)/unki
❑ PWS: `r �p
ORW: yes / ) PNA yes /� Closest Maj.Wtr. Body CT la kt [J `•` -k
Type of Project/Activity QC4)1A-CQ "hAfIcA c'eci4.in CHIC_ dAtMceck
0.S (Scale: ' �Z IUD )
Pier(dock)length
Fixed Platform(s) i
� r
Floating Platform(s) 62�J�
-
Gr
ngin er pierlength(s) (PLA0-0
t
...
...
number -
Bulkhe l/Riprap length -t- T -
1
avg.stance offshore ' I {
i I
max..stance offshore
��`'\
Basin,charm,. I �� _ R4�
cubic yards
Boat ramp r i
Boathouse/Boatlift }--_.._.._.---. __-_. _- .._. _.. �.____-._ _
Beach Bulldozing I \w` n l ,
Other 6,T7 40p 4 i
{ �� t 1 I
/� V t 1 , r .
Shoreline Length4r/'7_ `_( ' I 1 i
SAV: not sure yes ,(. I
, ' 1
Moratorium: n/a yes8 - ,('�� 10-k- 3-i +
Photos: yes f�(N i _..-�(.- } ;-. — �_
Waiver Attached: ' ,yes; no 50, ' IS Le-
A building permit may be required by: C i Qlr_ '...&(:),(k . ❑See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions p f\ Si Car\ CtV gl y cce'l E7'rckSZ '\ ivio— -4-
1- 10Z • Pt(\ 46 034-1,2ECCD ,k-c0-.2S . 9‘4.129 Ac-C-
kic,14 i Dv -
X, Q l u-C kit - er v c 4-
nt or Applicant Printed Name PermitOffic ' nt ame
V
Signature **Please read compliance statement on back of permit*"* Signature I LI

*CAMA / L.DREDGE & FILL j_54000,--
) N° 79975
;.lGENERAL PERMIT „..-
Prevk>us perrnit#
New [ Modification Li Complete Reissue ElPartial 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 I 5A NCAC:0-TH ., .- )0(._z_ _ _
Apphcant , 4
--.
Project
County )
Address L.12S PAN,.\10-0-Q4,
A- VA-- Street Address/State Road/Lot#(s) 2_612,1 I -rcilkuzfroA_
__-
Phone#(gio )2L. IV- .. E-Mail _ ______ _ _ __ Subdivision VkilSt)te... Ceo-k
Authorized Agent 'EN LC) 1, %,)t C .rS T*..,.)e,--- City ft ,'_ Car16*-- g?Pidet ZIP_2.154-tZ. _
cw VEW ).10TA I-I ES ripTs Phone# (._ _) ____ River Basin
Affected
...3 OEA ;i HHE _.-,IH E3 USA (I NA
AEC(s): Adj.Wtr. Body,
Closest Maj.Wtr.Body
ORW: yes /67) PNA yes
........
Type of Project' Activity R-C.*VC(2-
__1:-'4;a.`,6 _ _ _..._. (Scale: l ----.. /0 )
Pier(dock)length''..,.,• ,.,,.:,._,L._ — T
1 .4 . f' ' 4".' 1 '4 ' '''--- - -1---1-7 - :"---' -1-------- A ..
—---4--
I'loving Piat(orm(s) d;-(1. 3 I
..
r ger pieris) /. ., \))
,
Gr,in length A, ..64•-' '''• ,,,,. •
umber
. .
Bulkhe di RiPraP -rigtt 1 -- eios‘j4---:-
avg utance offsh,)re , .,,, -1
max.stance,
Basin.ccharm., ...
411
tei.
a -
= .N
ubicyard 1 ..
-.i/
Boat ramp_ ..
Boathouse/Boatlift _ _ _
' 1: - :---4-
___ _,, 1 • t + -,, : ---, . ,
,—..
Beach Bulldozing_ _ ___
- . .
Other_ _ 6. kVA?
Shoreline Length4r17..-•'"1 ....... 1.,...
,- .... IL e‘.51i-k,\A-C I- '
Moratorium: ,(-)-- )
SAV: not.sure Yes d"." ..4...9 1 \
.."-" t*.l.k)\11 \`;'‘,\.,...-0
I IQ k• 'S
Photos: Yes iii. \OA' I r,„.0
Waiver Attached'1---+(Z- Ss3 no
—' 'See note on back regarding River Basin rules.
A building permit may be required by: aLg,)P'IP.,__3_CCX_CV'\
(Note Local Planning jurisdi
Notes/Scecial Conditionsction) o .. “Zc C-Ika..C9 06-ir
_---
. .'
.F. `,;.,____Apoc__. ‘t., , -
L-7-- -
)
C _
Plea
-lierrnit-lEnt'n...,. L")
____
4`
" ei;0 .compliance stateent on back of permit Signaturl
Signacti4/ m

•
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: 1)e-re---4 e „rite- `3 I-
Mailing Address.
Phone Number
: /D � �`6 �-`
Email Address:
I certify that I have authorized Agent Cortracto;
to act on my behalf.. for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development.
//,‘ fr/b--r-is
f3 «4,
at my property located at 5 S C..' o o
3
in N lfA'vo c�../c Co u nty.
I furthermore certify that / 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;
Signature
`l lcLita 6c (-
Print or Type Name
QU
Titl e
1 i v j ( 2 1
Date
This certification is valid through I I

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: / SC- e /
Mailing Address: r„-L)ane
2kz
Phone Number: 9`/o
Email Address: fa�le �yS2P9c �CA/et
I certify that I have authorized 16Cc. 5
Agent/Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 12tp � � <<1 72"
pre vi t.,j aw e�
at my property located at (1r/p �3 2/7 7 �wo //-
in /-)c-‘,,J /-ii-ovev-County.
I 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:
Sig re
Cc /c L/
Pr t or Ty Name
Title
ll l I Z/
Date
This certification is valid through I I

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ,__ %c�C�/� f��(0C; .S
property located at 5��/O 3� ( Name of Property Owner)
on Al ��Q 6fo�� n(Address, Lot, Block, Road, e 1
f
in C�}/1aLtn/�} 71'� rt. , N.C.
(Waterbody) (City/Town and/or County)
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 AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
/,0 /G c1Q. -1 1 va/� /o m<<Ar d o ( PC
4n-ey, Zry. fre vi a L{ 5 /icmi i t 4
WAIVER SECTION
I understand that a pier. dock, mooring pilings, breakwater. boathouse. lift. or groin must be set back a
minimum distanc- : :-` my area of riparian access unless waived by me. (If you wish to waive
the setback. y. - he appropriate blank below.)
I do wish to waive the 15' setback requirement.
K.)
I do not wish to waive the 15' setback requirement.
(Prope Owner Informa ' n) (Adjacent Property Owner Information)
zgudrur / Sri
fi
Print r Type Na e Prin" Typ me
42-5 daciv ote-cc y Ad ��� boa. a 12
i ar n Address l 1 d&J I G
(Ai Gi Jti NL �' VV 'V
City/St e/Zip t O City/St fey ip
� � 6 �— � 3 � D -&I —30(7
Telephone Number Telephone Number
7/0f ,-- ) 07 /61 (ZI
Date Date
(Revised 6/13/2012)

. ADJACENT RIPARIAN PROPERTY OWNER STATEME T
I hereby certify that i own property adjacent to AA C girt v J,12 sz. 's
(Narnk f Pr rty Owner)
property located at 911,0
//f 33 .71
`1 t nn,-
/ (Address, Lot Brock,.Road, etc
on ( - ���V� �� �
in a, o/iw� /Scr�L� N.C.
,� (Watetbody) (City/Town and/or County)
The -•plicant has described to me, as shown below. the development proposed at the above location.
1
It ' I have-no objection to this Proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
1 21,ick(z0,-,.cot 01' 12 ef( t
om c‘t Ao_
.,„Is (0,, ,N.„,,,,,.6-etvlie--
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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.
0
I do not wish to waive the 15' setback requirement.
(Property Owner I. s-. to. (Adjacent Property Owner Information)
Signal, e % Sic'n ture ___
c< — Va c',ci(4 `V bo v\ oco, Y.,
Print or Typ- e Print or Type!Vamp
2/7 "Tcc... wood .--- 7J „.., Dr.
Mailing Address . Mailin Addres
C'Q.-0/,�. <3 �� vc Z�ryz� l' 6 ash ,vc Z�y
City,'State2ip Cityi tate Zc
!io 38-(e ce-6.5-3 Sig-6Z 1 --L13/0
Telephone Vumber Telephone Nu 'er
- 1�//2J__ _ I Z-1
Darr?
'Revised 6/13/2012)

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