Sloan, Hamilton 87391C

0 1+jOASr", c❑CAMA ❑ DREDGE & FILL N9 87391 A B C D
Previous permit
i = GENERAL 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:
I SA 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 11 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
(Scale: �-.)- )
Shoreline Length
Access Length
Pier (dock) length
Fixed Platform(s)
Floating Platform(s)
Finger pier(s)
Total Platform area
Groin length/#
Bulkhead/ Riprap length
I.;
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
SAV observed: yes
Moratorium: n/a yes
Site Photos: yes
Riparian Waiver Attached: yes
A building permit/zoning permit may
Permit Conditions
U IAK/YAM/NLUJt/bUrYtK (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

`°""41 ❑CAMA ❑ DREDGE & FILL N° 87391 A B C D
ti� 9
y = GPrevious permit
GENERAL 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(s)
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 no
Site Photos:
yes no
Riparian Waiver Attached:
yes no
A building permit/zoning permit
may be r
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
Signature "Please read compliance statement on back of permit"
t l ,
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Sign4ture
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: oq jr, i / s�pN T1.
Mailing Address: 211 �''►y%�� Q�v�
N G . Z-x1/ 2
Phone Number: L/s5-- 34
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:
& Kkffi'O
at my property located at 211 /3�ru) 131cW 411aAAr, A-
i n County.
1 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:
Signature
C4 ru s / w,14,oly 51oo,-I
Print or Type Name
0WM4-"--
Title
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Date
RECEIVED
This certification is valid through I I
MAY 11 2022
DCM-MHD CITY

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DIVISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER N07IFlUM
FORM
I hereby certify that I own property adjacent to the above referenced property. The individual t 17t(.&
applying for this permit has described to mo as shownff,
have uo �bjatioa5 toIhis p possL t ive objections to this praposat.
tlyoulam objections to►eWisbeingpmp Yvumusino�L)fy ClNisionofCoastaiManagement
(DW in writing within 10 days of mcelpf of this notice Contact itrfomwtbn to Mm offices is
evaflabfeaitrit;tAvww.nccoastalmanaoemenLnelhvelYrntlstaNJistiaGorDytatlirrg l 8861RCOAS7
No response is considered the same as no objection if you have been no6r*d by Certified hfall.
WAIVER SECTION
I understand that a pier, dock, mooriq pTi qs, boat ramp, breakwater, boathouse, of lift must
be set back a mini num distance of 15'from rAy area of riparian aocess unless waived by me. Of
you wish to waive the setback, you must initial the appropriate btank Wow.)
I do wish to waive the 157 setback rmqu'rrement
��Iotwish to waive the 15 setback requirement
{Property
7
Pik or 1�1* Nan
t�e r!i � t �( / �1��Ji� lt•
refephane
(Riparian Property Owner Intormation) j
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a ,
' t or Type Name
i`oC--c-a�"-IV
AlagM Address
/0 �-takA 1 \ � Qt eY
Dale Date
NJI e w0-e-.
ECEIVED
MAY 11 ZOZZ
DCM-MHD CITY