86466A - Chipley, Dianna

❑CAMA ❑ DREDGE & FILL
a 1"
GENERAL PERMIT
Na 86466
Previous permit
Date previous permit issued
A' B C D/
New ❑ Modification ❑ Complete Reissue [-]Partial Reissue
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 ` % ❑ Rules attached. Q General Permit Rules available at the following link: www.dgq.nc.gov/CAMArules
Applicant Name
Address
City >i State ZIP
Phone # ( ,_t D - s'). ^
Authorized Agent ?: i t , L
Project Location (County):
Street Address/State Road/Lot #(s)
Email Subdivision �l n._f 7,1
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body. (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWs Closest Maj. Wtr. Body I f.L
ORW: yes/no. PNA: yes/no
Type of Project/ Activity -
(Scale: c )
Shoreline Length
14
Access Length ;-
{
Pier(dock)length
Fixed Platforms)(�-
I
Floating Platform(s)
Finger pier(s)
Total Platform area �!
Groin length/#
Bulkhead/;Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAv observed: yes , no,
Moratorium: , n/a yes no -
Site Photos: �. yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions ).
j
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name Per Offic r'sPRINTED Name-,
ti ��-
i n
Signature "Please read compliance statement on back of permit" Signature ;
Application Feels) Check #/Money Order Issuing Date Expiration Date

N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date /z Z/, Z `
Name of Property Owner Applying for Permit:
apl?--t Z, Ov
Mailing Address:
I certify that I have authorized (agent) /)arll ���Jr 1417 to act on my
behalf, for the purpose of applying for and obtaining aU;`CAMA ermits necessary to
install or construct (activity)` �vl
at (my property located at)
This certification is valid thru (date)
Property Owner Sigpature a 1--r Date

DIVISION OF COASTAL MANAGEMENT
ADJACENT Rip Et" pROpERTY OWNER NOT109AMN FORM
CERTIFIED MAIL . RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby certify► that I own property adjacent to '01'a11 q
property located at
twa� o� Property Owner)
/) G ( Site: Address, U4 9hWk, Road, e6c.) -
on �-G(YJ'7 �GCU� O� in
N.C.
(W y) (City/Town and/or county)
Agent's Name k. !/,qr vJ 5-21t Mailing Ad Wnw /90 geK 2T
Agents phone #k 5-7'7- 77 / &=I'Gtw C 0-Zl j
He/She has described to me as shown below the development he/she is proposing at that location,
and I have no objections to the proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(lndiv W proposing development must f/ll in desCiiption below or afiach a sine mowing)
o O
r
23
•• Y%aw ssarez vyetiuwA W wnWJ5 oen9PrqPoseo& you mustnotiiythe DiOfti n ofC asW�
(DCAf) in wrung within 10 days of receipt of this notice Canespondence should be mailed to 401 S_
Griffin St, Ste 300. Elizabeth City, NG 27W9_ DCU asentadves can also be contacted at (264 264-
390i. No respov�se is considered the same as no objecam /f Yon lum been notified bV CeKified Alall
(Property Owner Information) (A 'cent P
i rty 0
or Name 1
Mating,
'c _ff
v`I®I T Ncn�bsr/Fine
Um
'Valid for one cae„dar yew after signature*
M�1

DIVISION OF COASTAL MANAGEMENT
AD•lACENT RIPARIAN Eftgf iaTY OWNER KQME CATION FORM
CERTIFIED MAIL • RETURN RECEIPT REQUESTED or HAND DELIVERED
I hereby cerMy that I own p.operiy adjace rit to 1 a L ('tlii /e 61's
isc sd ��l xGtl4,j �' of Party
�e
Site: Address, Lot, Bloek, Road, etc.)
on _ , UI'r'I u C '�l in �9=r��i
-� N.C.
(Wabmtody) (CitylTown andlor County)
Agerns Name 1: /�r� u ,5d'�ti ma ring Address: _ /00 go A 1—'�'7
ads phom*- 7 4/c 279 3�
He/She has desmbed to me as shown below the development he/she is proposing at that lorAtion,
and I have no objecfions to the proposal.
_ DESCRIPTION ANDJOR DRAWING OF PROPOSED DEVELOPMENT
Mcft-ockwd ptVposmg deve nve nt must fill m dbscdption below or affach a aloe airawLa
G'
Z3
[fj
Ifyouhave obb jecbmm to wind is beMgpr IPA younustnooffyMeDhMim orb
Mcle in wriffiv wftfdn 10 days of resew of thm nc shoWdbe imnaned fo 401 S
Gr WM Si, SEe30Q Cf1i n M ; 27909_ MMIRMesmtWves can also be oanftctedat r2k2) 269-
390i_ No nwPanse is Mmdwed the same as no objectka fiyou have been noMedbyCMffffed Mak
(Property Owner Ird6nnal ion) {Adja It Ptope 71=
)
Prntar'nM Now Pint or Type Name
& �7�1��a��,r-rue 11,12
um'l VA MN- gAddress
art -
��s� �3 4�73,5'
fEeaeyTl M*m Tetepi oa.IV r 81w '
v .. ( � c7l 7'-�'
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,�'-T_ � t

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