Parrish, Hazel 88384C

CAMA ❑ DREDGE & FILL
N° 88384 A B
+ ENERAL PERMIT
Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete Reissue
[:]Partial Reissue
As authorized by the ta`tf North C(of Environmental Quality and
the Coastal Resources Commission in an area of environmental concern pursuant to:
1rooliliinnfa.DJ�partment
15A NCAC�Rules attached.
❑ General Permit Rules available at the following link: wwwdeq nc gov/CAMArules
Applicant Name
Authorized Agent
Addr
Project Location (County):
City State ZIP
Street Address/State Road Lot #(s
Phone #
b ( �� ii)i2
Email
SuhdivNren
City ZIP
Affected ❑ CW MEW PTA ❑ ES ❑ PTS
Adj. Wtr. Bod an u (nat/ k)
AEC(s)�:(� F—]OEA ❑IHA ❑$PIMA ❑PWS
Closest Mal. Wtr. Body
Cl 6es/do PNA: ves/db ' 1
Type of Project/ Activity
Shoreline Length —7
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platforms)
Finger pier(s)
iotai vianorm area
Groin length/A
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length ✓�
Basin, channel•—
Cubic yards
Boat ramp t
Boathouse atl
Beach 1Bulldozin
Other W.
SAV observed: yes
Moratorium: n/a yes
Site Photos: y
Riparian Waiver Attached: l/eN7)
A building permit/zoning permit n
PAf
❑ TAR/PAM/NEUSE/BUFFER (circle one)
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address:
e—
'91,
Phone Number:
Email Address:
I certify that I have authorized
2-52- -? :�-Z4 7
C3 Scott, Inc
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:
at my property located at
in�l t
=Y"kLrti County.
1 furthermore certify that I 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
i . ; "le-1—
Title
-�,, lI //l ;
Date
This certification is valid through G{ I I L ?�

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to �l `2-� ( —'s
Name of Property Owner)
property located at cit I �-
` (Addr ss, Lo lock, R d, etc.)
on rGj� )C-�' _ JC_Xk -�-t in CL"p2 ��6 de--( , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
lQcdtion.
J I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(ir3aivid'4�l pi'aoiii#iirrtli�s7hl?0w 9�fc dPavt►i),
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me.
(I/(If ou wish to waive the setback, yoU`trfjlb j the appropriate blank below.)
I do wish to waive the 15' setback requirement.
V I do not wish to waive the 15' setback requirement.
Telephone Number/email address
Date
(Adjacent Property Owner Information)
SlinaturP1� 1
Print or, Type'Name
]7^�/c=
r�E JQv 2 �-
Telephone Number / email address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

I hereby certify that I own property adjacent to (41asZ e (Y I h s
—_ (Name of Property Owner)
property located at "/ . — I \
yy,, g (Ad ress, L-t, Block load etc.)
on r l<`1ucr'ir in'( -()-eM�i(— N.C.
(Waterbody) (City/'fown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locpAion.
89 I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, 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`. ft'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)
7-7
Si tur '
Print or Type Name
C5i Nnt lt.i c I�i+ tvC_
M ling Addre.4s 1
City/Sthtelzip
2G r . :-15-1--( �P!
Telephone Number/email address
Date
(Adjacent Property Owner Information)
Z-/—/; �
i` w p J 1'4
Print or Type Name
Mgigng Addre� , .,,✓.
C lkIJr�
City/StdtelZip
Telephone Number/ email address
Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*