84555C - Davis, Daniel

Sac'CAMA ElDREDGE & FILL NO1ous 84555 A B C! D
Previt
GENERAL PERMIT Date previous permit issued
INNew ❑ 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 (,i 7 IA ' 1? 00 ❑ Rules attached. 1Z General Permit Rules available at the following link: wwwden nc gov/CAMArules
Applicant Name rj)0+4 `)/1 VIA Authorized Agent
Address 1�; Project Location (County): /'/��>�(��✓�
City Cv�-IToN State Wl ZIP %( _ Street Address/State Road/Lot#(s) )2O �ulyi Aft 12 21'lf
Phone#(uI ).�/3��`�) �I_
Email Subdivision q p
City 1l I)L1• , (, , �ZZIP
Affected CW ® EW PTA 12 ES ❑ PTS Adj. Wtr. Body If, as �� l,,_-' /,1)U%/i A 7 P &a man/unk)
AEC(s): ROEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 0
ORW: ves/nol PNA: es no
Type of Project/ Activity
Shoreline Length i ,�
^t
Access Length C� 26'
Pier (dock) length _6;> V36T
Fixed Platformtsl 1, sL 10,
Floating Platform(s)
Finger piers)
Total Platform area I /Oti
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore ..
Breakwater/Sill ✓"
Max distance/ length _
Basin, channel
Cubic yards r'
Boat ramp r'
Boathouse/ BoatliR
Beach Bulldozing
Other A)n FN2M407-t A SLIPS
SAV observed: yes no
,) f7
Moratorium: n/a yes o
'
Site Photos: �es no
Y ,
Riparian Waiver Attached: l no .1 ;
A building permit/zoning permit may be required by:
Permit
N
f
(Scale:l)', )
I AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial) >r �/
t)
Agent or.Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature *'Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature
/,..-L V 2—
Issuing Date i Date

+00M74 ❑CAMA El DREDGE & FILL N9 84555 A B C D
a 1 GENERAL PERMIT Previous permit
t 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: wwwdeq n�ov/CAMArules
Applicant Name
Address
City - /) State It ZIP i
Phone#(_)
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot
Subdivision
City
Affected ❑ CW HEW Q PTA ❑ ES ❑ PTS Adj. Wtr. Body (nat/man/unk)
AEC(s): ❑ OEA ❑ IHA ❑ UW SPIMA ❑ PINS Closest Mal. Win Body
ORW: yes/no PNA: yes/no
Type of Project/Activity i '�� ��- ( i t C, I', (i
(Scale:; _ )
rti_._':__ I __µk
Access Length
I—'
—
_..
r-_
!
er
Fixed Platform(s)
Fixed Plattorm(s)
I
Floating Platform(s)
dl
-Finger
pier(s)
Total Platform area I i ii.
Groin length/R-
Bulkhead/ Riprap length—
--i--
Avgdistanceoffshore
Breakwater/Sill-
Maxdistance/length
Basin, channel
Cubicyards �—
'�
J_.,
�—
Boat ramp
_
_
Boathouse/ Boatlift
Beach Bulldozing
Other 1ex
SAV observed: yes no
Moratorium: n/a yes no
Site Photos:
-----�—
(
/
+_
)
...
__{__
—
yes no
r(i._
___.
Riparian Waiver Attached: .-ves no--_
'_
.�_
....:.__
d
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 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 ofpermiN* Signature
(It) a
Application Feels) Check ft/Money Order Issuing Date Expiration Date r

ADJACENT RIPARIAN PROPERTY OWtflN�ER STATE_M_ENT
I hereby certify that I own property adjaceht to l � vi ✓ r,
Property located at (Name of Property Owner)
on MC t ddress Lot Bloc Road etc.)
— ek' t'4tr' (liA y N6Pr�-� dA�.i� �� , N.C.
I
(City/Town andlor County)
The PP 'cant has described to me, as shown below, the development proposed at the above
1OF n.
I have no objection to this proposal.
--- ---- I k-.,_ -- ..
DESCRIPTION AND/O
(Individual R DRAWING OF PROPOSED DEVELOPMENT
Proposing a mo„ lyustfi, In attach a site drawing �'tC )
fie$ ,
�7
So
o,�f
—, W "Je
I understand that a pier,dock, moorin LVANE�--- RAN _ y_
back a minim um distance of 15' from mpila area oferi aratn abeatthouse;or
wis o waive the setback, you must init al the a ro hate blank below.) groin must be set
ss unless waived 6y me. (It you
� � PP p
—� I do wish to waive the 5' setback requirement.
— I do not wish to waive the 15' setback requirement -
(Property OwnerInformafi .-i

IIf /3g--lyy LEED'S
AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Properly Owner Requesting Permit: Il Lr ,
Mailing Address: I Pt Nqvf N 7y �P
C
Phone Number: 419'$oS g5$D
Email Address:
I certify that I have authorized �olNJd t7f rIX��
T— Agent I contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: Dok
at my property located at.1 aT c 6, oyw C elk- ?Apeisvj am
in J�/ j/0 / County.
l furthermore certify that l 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:
2,)C Q
Signature
Print or Type Name
o wNCy-
Title
Date
This certification is valid through-7-1 )Jp /
L 426

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to ALI, (.' l_/j/a✓r, _— 'e
L 11(Name of Property Owner)
property located at t4 : 6 °7 2 ---- —
on
The applicant has described to me, as shown below, the development proposed at the above
loc��on.
?C� I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development
must fill in description below or attach a site drawing)
rg
P° r ,,77
1� Wa Rpa,9t�Rt�t
WAIVER
ckarst ini that i pier, dock, mooring pilings, breakwater, boathouse, lift, or groin must be set
back a minimum distance of 15' from my area of riparian aaess unless waived by me. (If you
wish to waive the setback, yom
u ust initial the appropriate blank below) K—�` _
%t `�� I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
—pertpert _
(Property --(OwJner Info mation)
Sty re —
_�9AV, —
r A,rn
r -9
2G
7
(Adjacent Property Owner
Signature -
Print nrT o r"�`
YP Namo-
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