Tyson, Jeannie 77140C

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CAMA / El DREDGE & FILL j%% 40 A B D
-. GEN AL PERMIT Previous permit #
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 D�YI • �� (.'
'5CRules attached.
Applicant Name ❑ I ® Project Location: County
Address A Street Address/ State Road/ Lot #(s) � vnj
City -S State �GZIP� ae k
Phone # & /0-51WE-Mail ''-' Subdivision
Authorized Agent iLk!--V% S60US - City ZIP
Affected ❑ CW w PTA ❑ ES ❑ PTS Phone # ( ) River Basin S
AEC(s): ❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ N/A Adj. Wtr. Body jt
u Se-
na n /unkn❑ PWS:
ORW: yes / PNA yes/ no Closest Maj. Wtr. Bo
Type of Project/ Activity
Pier (dock) length
Fixed Platform(s) —�
Floating Platform(s)
Finger pier(s)
Groin length
number
Bulkhead/ Riprap length
avg distance offshore r
max distance offshore_
Basin, channel
cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
t
Shoreline Length 3 -X1
SAV: not sure yes
Moratorium: n/a yes no
Photos: yes
Waiver Attached: yes no
A building permit may be required by:
( Note Local Planning Jurisdiction) '
Notes/ Special Conditions
i
KJ: v sp
or Applicant Printed N me
(Scale:
50 LA ❑ See note on back regarding River Basin rules.
F,
Sign lure ** Please read compliance statement on back of permitQ 8 Signatur �J
C�M' oa- --- YL/V'o I J
Application Fee(s) Check # Issu' g Date E piratio ate

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
`,Name of Property Owner Requesting Permit:
Mailing Address: �S� 7 —[k At V �✓'
Phone Number: Z SZ- �� 7 O — _S:7 2-� ?j a
Email Address:
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: A'Q'Q C'—
o / J 131P 4 vim, o N Le LA-AK-cc—t
at my property located at L �J1 oi4-LQ �li�j /"
in aA-Ir' County.
1 furthermore certify that 1 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.
Information:
Signature
CC VAV\
Print or Type Name
Dew
Title
Date
This certification is valid through I l

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to' �A"` "` `�- t �d'` s
property located at I S-
Of
A
(Address, Lot, Blo k, Road, etc.
on ��`� , in N eL,-r L, N.C.
(Waterbody) (City/To and/or County)
The applicant has described to me, as shown below, the development proposed at the above
loca io .
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must till in description below or attach a site drawing)
'X , Lo
,lV�L1 l b �'�� 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 must initial the appropriate blank below.)
4-V ADS-
a-,L— —
S"�o &NMA
_ I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement.
Print or Type Na e
.056
Mailing Address
Cl y/State/Zip s
�I SG a5 / LC
+� elephone Number/email address q �LQ_� ce-�
Date S/ / � ?'O LV
"Valid for one calendar year after signature*
Owner
Pfint r Type Name
City/State ip "t- S,,h
�T )-IC o -2
elep�e�er/emaiilladdress �6 ,
9I1 I I l2-G /
Date*
(Revised Aug. 2014)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to -� AAI %V t i ' l 's
S (lyamerope O ner) C
property located at ` l �/L c� C��;(,cAi
(Address, Lot, Block, Road, a c.
on 1V� ��tre.,� in .C.
(Waterbody) (City/Town and/or C unty)
The applicant has described to me, as shown below, the development proposed at the above
location.
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)
�,A,�,Q4
a..CA-
` ' �0o At- 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 must initial the appropriate blank below.)
I do wish to waive the etback requirement.
I do not wish to waive the 15' setback requirement.
rty Owner Information
/ Z Y vl
---'Print or Tie Name
tVw/¢y �✓
Mailin r� P� �l`' D e X�L N G
City/Stl e/Zip
'Z o-'Z3o
Tel hone Number/email address
1eA ^jNI-L+-EAS," S6
Date '� � �
"V lid for one calendar year after signature*
A/L
Print
Information)
Li
City/State/Zip ,
z- S _� 1 �d.r
����
Tele hone Num er email address Cam'
// �' v
Date*
(Revised Aug. 2014)