Haigwood, Thomas 80028C

CAMA / ❑ DREDGE & FILL alb C/ N9 80028 A B <f5 D
GGENERAL
PERMIT Previous permit #
New ❑Modification ❑Complete Reissue El Partial Reissue Date previous permit issued
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 I SA NCAC ®�%�eECA!
ides attached.
Applicant Name7T&MA O, ot_tq.ylnn� Project Location: County CA f �iPS
AddressF Q Street Address/ State Road/ Lot #(s) 51m, ko
City I State /vim ZIPA.§ �
Phone # )916= W E-Mail Subdivision
Authorized Agent f) r City 1Z ZIP /�,, ��i
Affected OCWA El ES ❑PTS Phone# O River Basin �'t-/�
AEC(s): ❑OEA ❑HHF ❑IH ❑UBA ON/A Adj. Wtr. Body S Can L inat ma unkn
❑ PWs:�
ORW: yes L/ PNA yes
Type of Project/ Activity
Pier (dock) length (0 �rfi`f-
Fixed Platform(s)
Floating Platform(s) 9c
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore
max distance offshore
Basin, channel —
cubic yards
Boat ramp
Boathouse Boatli x
i
Beach PKilldozing
Othe I V
Shoreline Length J✓ U
SAV: not sure yes (9n
Moratorium: n/a yes
Photos: yes
Waiver Attached: yes n
A building permit may be required by:
( Note Local Planning Jurisdiction)
Notes/ Special Conditions _
Aj� Weld
e rAppicant Printed Name
S;
hu
(Scale:
El See note on back Jregarding River Basin rules.
/-- - rn An 'I/A t /il c�
11
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`Ir )�** Please read compliance statement on back of permit 5L-ll
Application Fee(s) Check #
Signa ure
2
Is ing ate Exp' ation Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: �M' ,yAS �,0/6HDO>
Mailing Address: 10,3
Phone Number: t�t /_-7
Email Address: '-i—e(/111.c���c�att &cL24AeG
I certify that I have authorized
Agent /Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 6 ��` Zy F'-zadTni6 PbC9
3 X /O � �ILurhiN�/N �ON6/�A�f7�� %�FryaU,O� OF f1��STi�L6 �xFJ �u4��FiSI+C(fp,�,�
at my property located at 103 /b'�PCF CdueT P/tiF f'i�atC 5��/1Ff, /�G
in CA2TC4R&T County.
I 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:
WWN GL �L
Signature
44'gLJ M
Print or Type
Title
/ 7 3
Date
This certification is valid through I I
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Cvk 1064
RECEIVED
APR 2 0 ZO
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. %NorYIA5 iklavovD
Address of Property: /a 3 / 66- 600,57- Nr /C'vdre SNo/le-!Ey /,6
(Lot or Street #, Street or Road, City & County)
Agent's Name #: Aripy- New
Mailing Address:
7"If
00 A/a2P06 zy
Agent's phone #:052-66S-V778
1yep 1,/vC
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I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing with dimensions must be provided with this letter.
—I have no objections to this proposal. I have objections to this proposal.
If you have objections to whatis being proposed, you must notify the Division of Coastal Management
(DCAV in writing within 10 days of receipt of this notice. Contact information for DCM offices is
available at htto://www nccoastaimanapement net/weblcm/staff-ilstina orby calling 1-8884RCOAST.
No resoonse is considered the same as no objection if you have been notified by Certified Mail.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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 16 setback requirement
I do not wish to waive the 15' setback requirement.
(Property Owner Inf rmation)
Signature
%KoxIos- i%olaaboD
Print or Type Name
/OS /rl(tA Lt'.
MgUingAddress
P j ✓I e 61 o f/ 't /iiw4Cp' 106 o2'?S-4�z
City/Statemp I
gllo--:5S-3'71
Telephone Number / ErdailAddresir /ham ( ccXa
(Riparian Prope�formation)
Si eafure
JpAe,H S/y/TN
Print or Type Name
/ o 6 r'7 1e Cy.
Mailing Address
CilpWate/Zip
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Telephone Number/Em
��j7,2- RECEIVED
Date
(Revised Aug. 20((f,R 20 Z021
DCM-MHD CITY

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TOM HAIGWOOD
N,M WeX
103 MAPLE COURT PINE KNOLL SHORES, NC
NO W NR1'MWAV
IviW MIN. NC 28562
SITE PLANS
252-665-4W8
RECEIVED
APR 2 0 2021
DCM-MHD CITY

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER NOTIFICATIONIWAIVER FORM
Name of Property Owner. %No rw5 Mmoovy
Address of Property: /b Y /bfA 600eT 171A) &'Vba SNd2e's, N�
(Lot or Street #, Street or Road, City & County)
Agents Name#: Xrjw New
Agents phone #_ Z52 - 665'- y378
Mailing Address:_ 7ir/3A 0&7 1OW06 Ep
NeN 3'f NG Ze5-6 Z
I hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawing_the development
they are proposing. A description or drawing, with dimensions. must be provided with this letter.
V I have no objections to this proposal. I have objections to this proposal.
lfyou have objections to wiWis beingprgposeg you mustnotifythe Division of Coastal Management
(DChn in writing within 10 days of receipt of this notice. Contact infomration for DCM offices is
availableathtWYAvww.nccoastalmanaaement.neVWWcm/statf-listina orby calling 1-888-4RCOAST.
No response is considered the same as no obiection if you have been notified by Certified Mail_
WAIVER SECTION
1 understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, or lift 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.)
V I do wish to waive the 16 setback requirement
1 do not wish to waive the 16 setback requirement
(Property Owner I "oration)
_` I ALL �l� Fl
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Signature
%f{owny H,0160boD
Print or Type Name
Mailing Addrdss
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City)Wateop
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Telephone Number Email ss ilia: 4110
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Owner Information)
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Pint or Type Name
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Telephone Number/Email Address
3 j APR 2 0 2021
(RevjsedRW4N4JD CITY

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TOM HAIGWOOD
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103 MAPLE COURT PINE KNOLL SHORES, NC
3AI5 OL V AIWORr ROAV
RECEIVED
WW6EM4, NC 28562
SITE PLANS
252-665-9418
a
APR 2 0 2021
DCM-MHD CITY