88508C - Jones, Jeannie

COAS411 ❑CAMA ❑ DREDGE & FILL a.. 88508A B C D
9c
GENERAL PERMIT Previous permit
Date previous permit issued
New ❑ Modification ❑ Complete Reissue ❑ Partial Reissue
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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State ZIP
Phone # ( )
Email
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s) ' , ,ry 'y) ~ ;F y, , OJ'%�'' F
Subdivision
City -
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. Body
AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
(nat/man/unk)
Type of Project/ Activity II'
�
�• (Scale:`,.,, -
Shoreline Length f7
»� 3 e ) ` .. ... .... .. ... ... .... ... .. ... ......
....................................................._. _ ........._.................................. r.._.....................i............ ......................... .... .... .... •............... ......... ......... .... .... .................... .........
Access Length �_. > . --�- - _ ? 1
Pier (dock) length f. Fixed Platform(s)
Floating Platform(s)
I
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes w�
Moratorium: n/a yes ,` no� � ;
1 ;
Site Photos: yes no
Riparian Waiver Attached: yes no., „� gg t r'
A building permit/zoning permit may be required by:
Permit Conditions 1 J
❑ TAR/PAM/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 PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name
Signature**PleasJe read compliance statement on back of permit" .
�r
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

o�01`°AST'V ❑ CAMA ❑ DREDGE & FILL Na 88508 A B D
G
Previous permit
z E N E RAL PERMIT Date previous permit issued
❑New ❑Modification ❑Complete Reissue ❑Partial Reissue
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 ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name _
Address
City
Phone # ( )
Email
State ZIP
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
ZIP
Affected ❑ CW ❑ EW ❑ PTA ❑ ES ❑ PTS Adj. Wtr. 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
Shoreline Length _
Access Length _
Pier (dock) length
Fixed Platform(s) _
Floating Platform(:
Finger pier(s)
Total Platform are;
Groin length/# _
Bulkhead/ Riprap
Avg distance offish
Breakwater/Sill _
Max distance/ len
Basin, channel _
Cubic yards
Boat ramp
Boathouse/ Boatli
Beach Bulldozing_
Other
SAV observed:
Moratorium: n/
Site Photos:
Riparian Waiver A
A building permit/zoning permit may be required by:
Permit Conditions
(Scale:.,.~
❑ TAR/PAM/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 PROJECT AND REVIEWED COMPLIANCE STATEMENT. (Please Initial)
Agent or Applicant PRINTED Name F` Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Feels)
Check #/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: Je-aoo'-,Nc `
Mailing Address: t () Gt
1'3
Phone Number:
Email Address:
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: �� e
C a �k 4CA�- V-)-� T Aw
at my property located at � �� �-�1C,���
in 0 C/1 , \e'— County.
l 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.
Property Owner Information:
Signature
Print or Type Name
Title
-;0 -L
)OA / , / 2-0 Z
Date
This certification is valid through I /

A A ENT ME6MM PR PERTY QMLR gTA10gWT
I hereby certify that I own property adjacent to , i'4tN �' _ w _ s ��_. ��,.__'►
(Name of Property Owner)
property located at
on Ck �c (Address, Lot, 8lockMad, etc.) LL \ n N.C.
in ir�
(Waterbody) (C ttylTown and/or County)
The applicant has described to me, as shown below, the devek Wwt O'er A the abo'm
location.
ave no objection to this proposal. O
I have objeclJons to this proposar
DESCRIPTION ANDCOR DRAWING OF PROPOSED DEVELOPMENT
{individual proposing development must fill in description below or attach a site drawing)
Pier wiff be built by Bentley Brooks in compliance with 15' setback and CAMA
requirements. Construction will be concrete similar to Kafer pier at 1720 Island
Road. The pier will go in middle of lot (32.5 feet from property line) so that it
meets clearance at the end. The pier will be 132 feet long. T shape on end.
PAAIVER SECTION
I id that a lam= dock, moors pilings, boat ramp, breakwater, boathouse, lsfi, 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 dDwishto w0ive the 15, setback requirement.
I do FKA wish to waive the 15' setback requirement.
Prape�ty )
tt4ac eM Property Owner l "mun3tio►n
� �
k
N
Signature ; c �l e' esi;;
-
Print or Type Name
MkxngAddre
ddress
f'i
. . I o ,c�.ttt . 6U�r`
�► (A' i I
Ted Nuff9w/OMSI address
Telephone Number er»7 address �- •''�"
t
Dxe
(Revised Aug. 2014)
NaW for one caienda r year after sig Wre`

on
ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to
(Name of Property Owner)
property located at
L -�o 6 r, &�
(Waterbody)
1-13o � Ct'4 R'-;
's
(Address, Lot, Block, Road, etc.)
in }-�,Gr�C£,�� C�rr1 , N.C.
(City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
have no objection to this proposal. 0(•
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)
GC- � C' S -�-fix%�- 5 z O�
i C�t� 5'- CsI
CAf-
WAIVER SECTION
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.) 1 t�
do wish to waive the 15 setback requirement. (�?% qA �t
i� I do not wish to waive the 15 setback requirement.
(Property Owner Information)
Signat r
Print or Type Name
u CA A C-2- r .
Mailing Ad ctot
sf lv ,V _ -�� 1
City/State/Zip (� � C1 V
Telephone Number/ email address
Date
(Adjacent Property Owner Information)
Signature
Print or Type Name
Mailing Address
City/State/Zip
Telephone Number / email address
T 2 Z&Zv-
Date *
(Revised Aug. 2014)
*Valid for one calendar year after signature*

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