Laramee, Mark 84474C

;o*liZCO 41 FICAMA ❑ DREDGE & FILL NO 84474 A B C D
ffii,l
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 Namet(
Address
City State ZIP
Phone # ( )
Email '
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
n /A) �` � 1� (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
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 required by:
Permit Conditions
!01.
❑ 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"
Application Fee(s) Check #/Money Order
Permit Officer's PRINTED Name
Signature
Issuing Date Expiration Date

o1*OFCOAST4
1 ❑ CAMA ❑ DREDGE & FILL NO 84474 A B C D
y = GENERAL PERM 1 T 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
Phone # ( )
Email
Affected ❑ CW
AEC(s): ❑ OEA
ORW: yes/no
State ZIP
❑EW ❑PTA
❑ IHA ❑ UW
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 required by:
Permit Conditions
❑ ES ❑ PTS
❑ SPIMA ❑ PWS
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Subdivision
City
Adj. Wtr. Body
Closest Maj. Wtr. Body
ZIP
(nat/man/unk)
(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
r 'W
Signature "Please read compliance statement on back of permit"
Application Fee(s) Check #/Money Order
Signature _
Issuing Date Expiration Date

AGENT AUTHORIZATION FOR LAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: rtr � L "i SgwOee
Mailing Address: qLD S �5 o Ir �.
lPhone Number: g l
Email Address: f `'`� r�. s 3'S�-t� (5r-c lk; l , CoWL
I certify that I have authorized 1.
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
.41
at m property located at�--
Yp p Y ,
in County.
I 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
Ml<,- L":; Pq&��
Print or Type Name
6 \-19/tc.T
Title
Date
This certification is valid through 6 t 1 Q(0 1 Z
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4' wide DOCK
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19' Boat
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JUL 2 8 2022

ADJACENT RIPARIAN PROPERTY OWNlE R STATEMENT
l hereby certify that 1 own. property adjacent.to �,Iy 4 L.L9,�"� M et 's
�/ (Dame. o . P.ronee)
property 1004ted at 7 j
(Address, -Lo ock;. dad, etc.}
on ' N`'
in.'C�.
aterbod
(.
... .:- CitylTown--and/or-Co.u.nty)-
The applicant has described to me,as. shoal' below, the. development proposed at the -above.
location..
i have no - abjection to .this prbpos'l.
i have. objeetions fo this proposal.
i�ESGII.PT«N%I_AVN.Ea PROP.OSD .E��(ELC;PMENT
i proppropost mus fill in -description befog or attach -a'site dh4wingj
: �r or. it
DCM_M-U CITY
WAIVER SECTION,
I understarid...that; a pier,. Dock, mooring_pq(n_gs;::breakvate_r, boathouse; fift; or groin must be set
a a minimum distance .of (';from m. area of :ri Arian access unless waived by me. if ou
G
,:.Y: , R Y . ( Y
wish to waive .the: setback; -you must:in�t�al fhe appropriate blank be4ow.}
i do wish to Waive. ttie 15' .setback Cequirerrtent,
iLn6t Nish to aive.the 1.5' setback requirement.
.Pro .:. ,.. .. . .
(. p er lriforma ion
} _ (Adjacent Property Owner Information).
g Sigiiature ' .
Print or Type Name Pri t : Type Name. ,
M. IV, 'AddressPdin Address I
Gif fStat p CifY, StWOM
Te ephone Number Telepfiv --Numb r
Date Date
(Revised 6/1812012)

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E�����
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.v

ADJACENT RIPARIAN PROP ERTl� ��I(N8R,TATEMENT
J
hereby certify that V own. property adjacent. to _ �i,�-zL s
(name. of P.ropety. Omer)
property located at 0'�t- .
(Address, Lot 1 ck;:Road, etc.j ... .
on C 01( •-�'
: , in .r>t -L :�L
_... ..
-. laterb6d[A yj
;_.
The applicant .has described to me, . as shown below, •the. development proposed at . tho -above.
[have no -abjection to .this proposal. '
[ have objeofions to this proposal.
DES RIOTN. D/O:R: f)14AWJ.N.G �� E�RC}P.OSED �EV�LQ�M "T
(liidfvi u�l PrOPOS104: .vef®p Mt Lust fill'°art -de����� t Oq beta�r or aftach a's to drawing)
-
WAIVER SE.C, ION
[ undersfan, :that. a'" Pier dock, moor.[ t _ ,•:ilFngs, : real ate_r, boathouse; fift, or groin rust be set
P J gP 9 b g
-
back a minimum distance of f';frorn :rri. area of r[ Arian access unless waived b me, if ou
wish to Wavvve:the setback,'.:v66 u.' t
-�
ii fiai the appropriate blank be(aw.}
::• ;,
da wish to vuaive.W615'.setback requ[rer ent.
;� S
[ do -not w[sh to waive the 16' setback requirement.
.!
{Pro.: .. �. r lrit®rma�on , :
:. } _ '(Adjacent Property Owner fnfofmationj_
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Print or Type Name rint .or T
l�,, 4�4 L'
..
,.
M NIAg ., ddresa
o /1� ///1��� NpV Address
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_ . .
Ci %StaZf CifylState%Zip
e eotrone Number Telepone-Nu ber
_
t, i
=
i
Date Date
=
All. 28 ?W
(Revised 611812012)
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