Joyner, Larry 84177C

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COASr4 ❑CAMA ❑ DREDGE & FILL O 84177 A B c D
z = GENERAL PERMIT Previous permit
Date previous permit issued
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. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name V `° "
d
Address
City State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
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
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale,:
Shoreline Length „q
Access Length
Pier (dock) length µ` i
.......... ......... ........... .................. ....... ................_.................. ... ... ..
i Y
,
Fixed Platform(s) ,fit i „ `
j i
t 1
f
Floating Platform(s)
Finger g pier(s)
Total Platform area F r'
Groin length/# ?
i j 3 �
Bulkhead/ Riprap length � t r �"-j- --�-
3 `
Avg distance offshore
1. i ...,.,. ...�,,...." �..."..�.....,. ,....�..m....
Breakwater/Sill
Max distance/ length
3
.......,-cM..,.-mq- .... �,. .1-rm �....f iw.......... .M.. .. ., ...,.,
Basin, channel ij7 . /
.._ ......."_.. _. .�..... ...�y
Cubic yards
i ..� ..:..� ).._
Boat rams _ _�... ". _.j"
Boathouse/ Boatlift
Beach Bulldozing_
Other
SAV observed: yes no
Moratorium: n/a yes not i
Site Photos: yes nd ---- ............
Riparian Waiver Attached: yes no q, I
A building permit/zoning permit may be required by:
Permit Conditions
c ❑ 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
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

i
`°lu'`'� ❑CAMA ❑ DREDGE & FILL 9 84177 A B C D
GENERAL PERMIT Previous permit
Date previous permit issued
❑ 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. ❑ General Permit Rules available at the following link: vwvw.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
P
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity f, f
(Scale: )
Shoreline Length
Access Length _
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore _
Basin, channel
Cubic yards
Boat ram
Boathouse/ Boatlift 3
Beach Bulldozing
........................ a............
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:
❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

rfkdfkC^DWIVSIOOF COASTA L MANAGEMENT
AGENT AUTHORIZATION FORM
Nu me of Proper Owvet.Apply ing Tor Permit:
Mai ling.A.,dd ress
��� ;bK.
', �����1
Itertify, that. I -have authorized tagenti),
to act ion, my
behuXter the purpose of applyingfor and obtuWagiffliCAMAPermits necessal-N, to
install or construct (activity)
at '(m N, p ropes lora'ted Wrt)
Thi's certificatio.qlid thru (date)
Date

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �� �'� �/ t✓ d 's
property located at
qv 6pme of Property Owner)
{Address, Lot, ;�a��eton �`"''� in `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)
k*��
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.
I do not wish to waive the 15' setback requirement.
(Pro ty Owner Information) (Adjacent Property Owner Information)
Signatw-e
Siwiature
Print or Type Name Print or Type Name

Mailing Address Mailing Address
City/StatelZip
City/State/Zip
Telephone Number Telephone Number
Date
611812©12)
Date
(Revised

i hereby certify that I own property adjacent to �'� '' �` lJ is
of Property Owner)
property located a�
(Address, Lot, Bi R d, etc.: -_..
st
in
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 DRAINING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site
drawing)
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 yoi+
wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.z 1�
I do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent Property Owner Information)
Vgnatur•e S gnature
Print or Type Name
Print or Type Name

Mailing Address Mailing Address
City/State2ip
City/State/Zip
Telephone Number Telephone Number
Date
611812012)
Date
(Revised