Costa, Felicia & Angela 84565C

\1*piC0PSNJ ❑CAMA ❑ DREDGE & FILL NO 84565 A B C o
Previous permit
SF-7]
GENERAL PERMITDate 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/ho
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 required by:
Permit Conditions
at/man/unk)
(Scale:'_.
❑ 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

\1*piC0PSNJ ❑CAMA ❑ DREDGE & FILL NO 84565 A B C o
Previous permit
§F-,]New
GENERAL PERMITDate previous permit issued
❑ 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/ho
at/man/unk)
Type of Project/ Activity
(Scale:'_. Ei
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 required by:
Permit Conditions
❑ 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

°E`OASt414, ❑CAMA ❑ DREDGE & FILL NO 84565 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
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
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 required by:
Permit Conditions
t
(Scale:;
f�1
❑ 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

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit. he'21 'Ile Co 5' a
pi
Mailing Address:(71'a-f-f4it1dSIPK
,-� �Y� c�'
Phone Number:
Email Address:
certify that I have authorized
ehr
V 713.2- 596 a,
't ` r, -1 U-1
n . Z 1 11 -M, YYI I
y5y-0475 ,
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: DOf
at my property located at
in () 4 c�Iy,J County.
ll�
A,4. Yam' (ele 61,4
1 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
Print or Type Name
G? e y—
Titl e
Date
This certification is valid through / I )_ / 21�%
RECpvf7,0
MAR
�CMMSr� CITY
p r'.
Y_ r M
DCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEM—1 NT
that I own prop erty adjacent to r
1 hereby certify P P (Name of Property Owne ,)
ple
property located at
K
(Address,
on (�(-C ' in --
(Waterbody)
Road,,etc•) %
N.C.
(City/Town andlor County)
The applicant has described to me, as shown below, the development proposed at the above
locatio
«L a l have no objection to this proposal.
I haverbjectons to
----------- - - AND/a� ��A�11NG OF PROPOSED DEVELOPMENT
DESCRIPTION may.:
� must �i11 in description below or attach a site drawir���
(lndividcual proposing rleveloprner� _---- - --_-- - ---_
ote
A - ER SECTION --- - -
-- pier,.dock, mooring pilings, breakwater, boathouse, lift, or groin must be et
l understand that a pi , . me. If you
back a minimum dis
tance of 1 5` from my area of riparian access unless waived by � y
wish to waive the setback, y
ou ust initial the appropriate blank below-}
I do wish to waive the 15` setback requirement.
setback requirernent-
I d© n®t wish to waive the 15`
(Adj en fro ert� Caner Information)
(Property Owner Information)
21
o
P nL W�,
lefd I C i x C7 o
� y
0 ' t r Type Na e 4RL9�4S
'
M r ing Addre
Mail-ng Addres
C cue-'&°5t-,,gycity/state/zip G
City/ / tate1z, I � � S co
y Tele none Number
Telephone Number P S" 26 ZL.
�,/V j ,` J
�, '7 ' .� l ` — Date R�..:., _ . , d
Date .�
3 j at (,Revised 6/18/g012)
MAI) ,
DCM-MH D CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I herebycertify that I own property adjacent to �J i L' �
' j/ (Name of Property Owner)
property located at �
(Address, Lot, Block, Road, etc.
Ale -9 in eoz
on �4 e CY _e
at--L (City/Town andlor County)
( y)
The applicant ha
s described to me, as shown below, the development proposed at the above
location
I have no objection to this proposal.
I havebjecton_s_to
----.---- - --
DESCRIPTION AIiIDIQR DRAWING OF PROPOSED DEVELOPMENT
(Indtvid
ual prop ro osrn g cjevejopment must fill in description beiow or at.tach a site drawing
. ---
.,m
fe
Mailing Address
City/Staf ujp
��.�
Tel��5-
y��r.��� "
Date do
L.
lip
NE S ECTI.0 N ------ - -= -- -. _- ___.--
lings, breakwater, boathousein must be set
, lift, or groin
area of riparian access unless waived by me. (If You
al the appropriate blank below.)
aback requirement.
5' setback requirement-
(Adj, ent ro rty Owner Information)
-----------------------
Print or Type Ala e S % ►"e �,
a r 41,�- lilt?
M iling Addr-lss IV ,� 53
City/StafelLip G �� Z z
Telephone Nu be
Data RC N ED
(Revised 6/18/g012)

Ruler
1 ` I. - .. I Line 1 g.Circle . polygon 422r,Gar.land Shores DrMeasure the distance between two points on the ground
R7� �+ ,5 °�Y •
Map Length: 80.59 Feet
Ground Length: 80.59