Davis, Jay 84407C

"IICO 41I%❑CAMA ❑ DREDGE & FILL N9 84407 A B C D
0
GENERAL PERMIT Previous permit
Date previous permit issued
BNew ❑ 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
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(s)
r
(Scale:
Permit Conditions 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 Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit" Signature
Application Fee(s) Check #/Money Order Issuing Date Expiration Date

h�0
°ICOAS1A,& ❑CAMA ❑ DREDGE & FILL N9 84407 A B C D
Previy GENERAL PERMIT Date r 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
P
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 R
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
r
t
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 no
Moratorium: n/a yes ;'h.
Site Photos: yes no�
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by:
Permit Conditions
y` , (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
Permit Officer's PRINTED Name
Signature "Please read compliance statement on back of permit"
Application Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

The inaivii
I hereby certify that I own prop" adjacent to h on the Ch d drawing -the develo r
applying for this permit has deacribed to me as s
they are proposing.
PL� I eve objections to this propos,
� I have no objections to this propose].
(f you ha ve objections to what Is being proposed, you ►rust notff)'�e ,Division of Coastal Manag
(IaCM} In w71ting within 1t? days of receipt of this notice, Corrpondence should ba malled
Commorr..e Ave., Morshead City, NC, 28567. OCM res era nrrtatfv h� hee-11 o d U(J�
2808. No resoopse is considered they same s no ob r�tlon �
WAIVER sKT1ON
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;�ish tra ,aniv the c tt ack, yea a Mu lr the appfop
do wish to Wain; O the 1,y' �etbac� �eyuireri�ed
,j 1 do not vaic'�h to waive th(' ' r,etba(:,k r(,vq ,imment.
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Nam® of Property Owner Requesting Permit:Lief d le -
Mailing Address:
Phone Number:
Email Address:
I certify that t have authorized
to Tact on my behalf, for the purpose of applying for and obtaining
all LAMA Permits
necessary for the following proposed development:
at my property located at
In lC tr County.
n fact
rant perssion to
l furthermore certify that / am authorised to grans" and doer and their agents to enter
Division of Coastal Management staff, the Local permit Officer
on the aforementioned lands in connection with evaluating information related to this
permit application.
Property owner Information:
or Type Name
Title
This certification is valid through _,-__„ l