Carney, Bruce 78881C

CAMA / ❑ DREDGE & FILL `� / NO 78881 A B �f) D
NERAL PERMIT Previous permit#
ew ❑Modification ❑Complete Reissue ❑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 15A NCAC
ules attachet
Applicant Name Project Location: County a -
Addre s Street Address/ State Road/ Lot #(s)
City �l tate ZIP
Phone #�)���E- ail Subdivision
Authorized Agent City ZIP
-VCW EW .F-\ 'A ' ❑PTS Phone # ( ) River Basin
Affected O OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A t V�
AEC(s): Adj. Wtr. Body a 'man unkn
El PWS:
ORW: yes d PNA
yes /�
Closest Maj. WL Body
Type of Project/ Activity
cc
QJ
f
(Scale:' ;r- )
Pier (dock) length X
r
Fixed Platform(s)
i
i
Floating Platform(s) ✓
I ,
Groin length
c
number
Bulkhead/ itiprap length_
avg distance offshore r
max distance offshore/
Basin, channel
cubic yards - rk
Boat ramp 0.
Boathouse/ Boatlif[
Beach BU10001�r—
Other
Shoreline Length I r �—
SAV: not sure yes no
Moratorium: n/a yes
Photos: yes _ J._.
Waiver Attached: yes I cix
A building permit may be required by: ❑ See note on back regarding River Basin rules.
( Note Local Planning Jurisdiction, , f
Notes/ Special Conditions
r I l — 1— it S_ _ _ I J
Sign ture **Please read compliance statement on back of permit**
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Application Fee(s) Check#

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NC Division of Coastal Management
Cashier's Official Receipt
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Received From: W es4e (1 �.i n3 Q n C /tAaA e. , t
PermitNo.: �=1� '
Applicant's Name: IX l Q e Project Address: 33 (O II% t A An WOrJ4 ../A
RECEIVED
MAR 17 2921
DCM-MHD CITY
14499 A B(qD
Date: i ? 20
-621
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Check No.: q —2��k4 G
County: �`tf
Please retain receipt for your records as proof of payment for permit issued.
Signature of Agent or Applicant:
Signature of Field Representative:
Date:
�. 7,1 O

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MAR 17 2021
DCM-MHD CITY
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AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:U�-�
Mailing Address: l,D] A>J/ J6 1,)DWPS 10fl
Phone Number:
Email Address:
I certify that I have authorized
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: 'Qbcr-
at my property located at 3;3�g 011133>1 .4 LDe8
in GHCL 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:
Title
Date
This certification is valid through
RECEIVED
NOV 19 2020
.oCM-MHD CITY

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to f2lLV c'E C-i:)f-0di 's
(Name of Property Owner)
property located at 33 6 W 10
on t�£U)POtri— in
(Waterbody)
6 l>7a'a-D S G-�I
Lot, Block, Road,- etc.)
--1TJ5M
N.C.
The a plicant has described to me, as shown below, the development proposed at the above
loc
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)
T
a�b
45;r �_ IS!+ i°I t
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.
25�' 1 do not wish to waive the 15' setback requirement.
(Property Owner Information) (Adjacent I�oprt Towner Information)
Iv.�,yv
Date
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Pnn r ypeName
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Mailing A esc v /� A/ toy /fo
Won Number
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Dare RECEIVED
(Revised 6/W% 2020
DCM-MHD CITY

U.S. Postal Service'"
CERTIFIED MAIL° RECEIPT
Domestic Mail Only
For delivery intormation, visit our wehsite at www.usps.ii
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