84201C - Wood, Bruce

1*°E`°��'4 ❑ NO. ❑ DREDGE & FILL . 84201 A B C D
Previous permit
�O 9C
s 3 GENERAL 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 Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
Shoreline Length
Access Length _
Pier (dock) length
Fixed Platform(s)
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 n
Permit Conditions
man/unk)
(Scale,: )
❑ TAR/PAM/NEUSE/t3UFl-EK (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"
Check #/Money Order Issuing Date
Application Fee(s)
Signature
Expiration Date

o�°E`°"s'v
❑CAMA ❑ DREDGE & FILL N9 84201 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: www.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
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
j Type of Project/ Activity
(Scale: )
Shoreline Length3
? j _
i
Access Length _._ _,.. i _ m_ _ _._.
Pier (dock) length
3 i
Fixed Platform(s)
... ... ... ... ... ... .... ... ... ... ...
f;
Floating Platform(s)
i
i
f j
Finger )...................................................................:.:.... _.................
i
_.
3 r �.
Total Platform area '
f �
Groin length/# _ ? i _
Bulkhead/ Riprap length .......... ... ................ ... ......3,.... ..:' €..
Avg distance offshore
._._ Breakwater/Sill m `"
Max distance/ length
Basin, channel i
Cubic yards I
Boat ramp
Boathouse/ Boatlift l i
Beach Bulldozing
.a.. .
Other 3 1-
1
SAV observed: yes no
Moratorium: n/a yes no
l_. .......>_ �.... _, . _ . .. ..
Site Photos: yes no .._......._..
Riparian Waiver Attached: yes no .3��
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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
i
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

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N.C. DIVISION OF COASTAL MANAGEMENT
AGENT AUTHORIZATION FORM
Date -
Nance of Property Owner Applying for Permit:
Mailing Address:
3 q A 5 -W- Refd
/05 Rf k��Y 61z", 915-510
I certify that I have authorized (agent) rJ7 ��P to act un my r
behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to
install or construct (activity) A / l7Ca) �! ��� I '✓l �� ��� � r 7 , ` �� �
at (.my property located at) �I, ✓ ���✓` '��-�L�c
This certification is valid thru (elate)
fe 6,
Prol3e y Owner Signature
��f- � �" E
Date
1 of 1 2/11/22, 11:15

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I
I hereby certify that I own property adjacent to �Ucc-- wozop S
�gftf Ptr% rA nUfn rl
property located at
ell I f f"'i
A #�Ve vA-A/
(Address, Lot, Block,, Road, P err*.)
on jp� FnF, K in ff*e '—, 7
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc t'
5e 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)
NdyfiE
D21r�'�`�i_
P 0 ('.. rI'
o�f P Ff
ebi
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.
(Property Owner-Inf%matipiri)
(Property I
silth4T ' --l' -
k I., I'E filkp
Print or Type Natne bi-O
Mailing Address
cityista'
Telephone Nu5er
Am,
(Adjacent Property taw ns Information)
sigill ItIll
Print,qype INVa
Mailing Address
City,/State.Zp
Telephone Number
Date
(Revised 61'18,,,2012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
s
I hereby certify that I own property adjacent to ill'), 9
�N Name of Property Owner)
;2
property located at f41-1...... . .....
(Address, Lot, Block, Road, etc-.
on in I.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loc n.
t'9 1 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)
tj F"U�
f to- -r('V-6
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.
(Property Owner lnfotmati
7
P'i or ype Narne
L
Mailing Address
ACV �
city"I'st 1P
..
-Telephone —Number
A
Date
(Adjacent Propert weer Information)
Print or Type Name
�A4akx\\'
Mailing Address
cityl'state"211
� .. �a�
Telephone Nutvber\
Date
(Revised 6148,42012)