Crisp, Gail 84624C

�FICAMA El DREDGE & FILL N9 84624 A V C ; D
Previous permit
GENERAL PERMIT Date previous permit issued
,ONew ❑Modification ❑ Complete Reissue ❑ Partial Reissue
As authorized by the State
`7of{)NJgrth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
15A NCAC !� i / `7 i ° �J'- ���C.-/ ❑ Rules attached. Q General Permit Rules available at the following link: v ..deq.nc.gov/CAMArules
Applicant Name .2 a lJt \ l : `l 1 Authorized Agent a�i \ iJ `"'J -_ .A. P" /
1, I - . /.�.(� F,'_.. ,..
Address ..-_ �. � CA.f �1„� Project Location (Counwl: -
City - State 1 ZIP Street Address/State Road/Lot #(s) < 'i
Phone # (_ )
Email Subdivision
City
Affected ❑ cW ❑PTA ❑ ES ❑ pT5 Adj. Wtr. Body P-sih rn�. %O i A J I �..Ti� ((naym:tin/unk)
AEC(s): ❑ OEA ! ❑ IHA ❑ UW ❑ SPIMA ❑ PINS Closest Mal. Wtr. Body 0 (,10
OR .yes/no PNA: yes/no
Type of Project/ Activity
Access Length
■
■■
■
■■
■
■■■
■■■
■
Pier (dock) length
Fixed Platform(E)E�
Floating Platform(s)
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-
■
■■
...:..
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Finger pler(s)
ME
M::�':■�••IN
101ME
Total Platform area
M
0
EMS
Groin length/#
Basin, channel
Cubicyards
MR
Permit Conditions -
❑ See note on back regarding River Basin rules
❑ See additional notes/conditions on back
AM AWARE OF STATUTES, CRC RULES AND CONDITIONS THAT APPLY TO THIS PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Pleaselnitial)
L
lgent or Applicant PRINTED Name - Permit Officer's PRINTED Name
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Signature *'Please read compliance statement on back of permit*" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

L]CAMA ❑ DREDGE & FILL N9 84624 A B C D
Previous permit
3 3 G E N E RAL PERMIT Date previous permit issued
New ❑ Modification []Complete Reissue ❑ Partial Reissue
As authorized by the State of Nprth Carolina, Department of Environmental Quality and the Coastal Resources Commission in an area of environmental concern pursuant to:
I SA NCAC ❑ Rules attached. ❑ General Permit Rules available at the following link: w .den nc gov/CAMArules
Applicant Name
Address
City
Phone #
Email
Authorized Agent
1,
Project Location (County): i
State ZIP Street Address/Stare Road/Lot #(s)
City
Affected ❑ cW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. War. 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
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NONE
No
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A building permit/zoning permit may be required by:
Permit Conditions
❑ TARJPAM/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 PROJECTAND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
1j
or Applicant PRINTED Name
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check N/Money Order
Signature
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR LAMA PERMIT. APPLICATION
Name of Property Owner Requesting Permit: �y r
Mailing Address:
Phone Number:
Email Address:
I certify that I have authorized
4�5�--r-).L7-79Z
2�53
to act on my behalf, forthe purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development: _ : l-e uc d1 /<
/I .GrtroS,� E-,
at my property located at
in _ — County.
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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:
Signilture
Print orlrype Name
®C6!J e[,-
Title
- tLi3_i 7-0 2 2
Date
This certification is valid through /E- 1 -3 � l ,
M
44

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to 4cw : / C K t S ty s
(Name of Properly Owner)
property located at
q (Address, _o31ock�, etc
a�1
on VIIN(Citylion ndlor Co nt)a
The applicant has described to me, as shown below,.the development proposed at the above
Io�0,L,io,1
1. 1 have no objection to this proposal.
-- _ hI l .a_v--objQ-cftons tathis_p[oizosal`--------...._. —.._.
DESCRiP T ION AND/OR DRAWING OF PROPOSER DEVELOPMENT
(individuai proposing deveiopmenf m sf fill in description below or attach a site drawing)
VIVO
_ .n 1.n/f _ ..I0
L,,W %5
er
L'= CIS
pr pp ZF^T`�
Qr�cl
I understand that a pier, dock, mooring pilin s, 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.)
s I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
�53
Telephone Number
y-- M - Olt) ;1,
Date
(Adjacent Propefiy Owner
Signature
14n : �ek Oe, 1.5
Print or Type Name 0 n
12-!R Ile Zrs( GDv.F-11
rs53
(Revised 611812012)