86086D - Forest

COAr41c❑CAMA ❑ DREDGE & FILL N9 86086 A B I
GENERAL PERMIT Previous permit
J 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
15A NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: www.dgg.nc.gov/CAM.
Applicant Name
Address 1 1�
City ., y r)D State fs'.; ZIP
Phone #
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/m:
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no; PNA: yes/no
Type of Project/ Activity
(Scale
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
Moratorium: n/a
yes
Site Photos:
yes
Riparian Waiver Attached:
yes
A building permit/zoning permit m�
Permit Conditions
❑ TAR/PAM/NEUSE/BUFFER (circle one
❑ See note on back regarding River Basii
❑ See additional notes/conditions on ba
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial):
-16-?Z
Agent or Applicant PRINTED Name Permit Officer's PRINTED Name
7-15Z2
Cionnti— **Plcnco ronrl rmmnlinnru ctntcmunt nn hnrle of nurmit** Cia fi—s

,ment of Compliance and Consistency
)ermit is subject to compliance with this application and permit conditions. Any violation of these terms may
!ct the permittee to a fine or criminal or civil action; and may cause the permit to become null and void.
3ermit must be on the project site and accessible to the permit officer when the project is inspected for
fliance. The applicant certifies by signing this permit that: 1) prior to undertaking any activities authorized by this
iit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the
land use plan and all local ordinances, and 2) a written statement from the adjacent riparian property owner(s)
seen obtained, or proof of delivery of certified mail notification of the adjacent riparian property owner(s).
state of North Carolina and the Division of Coastal Management, in issuing this permit under the best available
mation and belief, certify that this project is consistent with the North Carolina Coastal Management Program.
Basin Rules Applicable To Your Project:
Tar - Pamlico River Basin Buffer Rules Neuse River Basin Buffer Rules
licated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules
he River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the
)ivision of Water Resources. If you have any questions, please contact the Division of Water Resources at the
,hington Regional Office (252-946-6481) or the Wilmington Regional Office (910-796-7215).
es/Additional Permit Conditions:
ensure all debris associated with the removal or construction of the permitted development is contained within the authorized
:t area and disposed of in an appropriate upland location.
Dn of Coastal Management Offices
head City Headquarters
ommerce Ave Morehead City, NC 28557
08-2808/ 1-888-4RCOAST Fax: [phone]
as: Carteret, Craven — south of the Neuse River, Onslow
ies)
ieth City District
. Griffin St. Ste. 300
eth City, NC 27909
64-3901
m Bertie, Camden, Chowan, Currituck, Dare, Gates, Hertford,
Washington District
943 Washington Square Mall Washington, NC 27889
252-946-6481
Fax: [phone]
(Serves: Beaufort, Craven — north of the Neuse River, Hyde, Pamlico,
Tyrrell and Washington Counties)
Wilmington District
127 Cardinal Drive Ext. Wilmington, NC 28405-3845
910-796-7215
Fax: [phone]
(Serves: Brunswick, New Hanover and Pender Counties)

^INa , T.
E

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: T ()►j:l
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
i i 11 r -�- JI., .Ind J A/r -11 Yi
Aaent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
I C I. k/
at my property located at z
in J9 - County.
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
rrvI r Foh
Printjr Type Name
Title
l�l Z L
Date
This certification is valid through I I Z t

S `l S S 5 L1 S H 4 q, c 2
FUrres �- $7e)r7cl 20 Z Z
Savrds nos 0, t4LW Jt, z
sh a 4d arms 6v be C��
% Sit it mLLr
ao, 300 Yards

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to i Jn° f t </9/" 7 t� l` s
!�
(Name of Property Owner)
property located at 1-! � 1-i,,.. , ` _ /- /
on _ �('� � / (Address, Lot, Block, Road, e� A /�__�� N.C.
` in Uc-
(Waterbody) (Cit /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)
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 Information) (Adjacent Property Owner Information)
Signature .r � rS� g bt ture
t, -n r� ` —
Print or Type N e Print or Type Name (
12 Ho ro !d0 t / I q
Ma
thn ress cavvo�•�i 5 0
S M fling Add essCtYIStae;010-
UG .
_ .� 7 0� I S City/St e0p
GrJ
Telephone Number � / 7- V&o
Telephone Number
Date 3 / 2
Date
(Revised 6/18/2012)

Today 11:09
Delivered
Dave Gardner has
permission from
FSHA to place
dredging spoil in the
field that we own on
Howard's lane.
Hal Fogleman
FSHA MARINA
CHAIR

read
Date D.Pwffed Cheek From Name
Name d Parmk NokW
YYndw
Ch-k number
Chaok
amobnt
Perm& N=barlCommante
R—fot a Ref—&Rwllacated
1
Cn1umn2 Cak-3
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C"k 6
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!022
1022
Backwater Marine of NC LLC
_ _ Jeffrey Vogel
Bartlett
same
BB&T
South State Bank
_ 1460 $ 200.00 GP #8M15D _
511 $ 200.00 GP #86014D
BB rct. 16918
BB rct. 16915
!022
_ AMW Docks & Marine Construction
Beckman
Truist
7079
$ 200.00 GP #86010D
BB rct. 16920
!022
Sea Dog Marine Construction
Will
First Bank
1664
_
$ 200.00 GP #86015D
BB rct. 16919
!022
Southem NC Marine LLC
Penegar
First Bank
1504
$ 800.00 GP #86087D
JD rct. 16820
!022
Topsail Offshore, Inc.
Forest Sound HOA
Coastal Bank and Trust
1405
$ 400.00 GP #860860
JD rct. 16308
!022
!022
James Hardin
North End Builders NC LLC
same
Williams
State Employees CU
SunTrust
3544 $ 200.00 GP #86023D
1092 $ 400.00 GP #85412D
JD rct. 16304
BH rct. 16268