Toma, Basem 84484C

((IY
CAMA C DREDGE & FILL N9 84484 A B � D
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:
I SA NCAC .�%'1� f�� I �[-/ - ❑ Rules attached. General Permit Rules available at the following link: www. .nc. v/CAMArules
Applicant Name
City �A✓)rct -T State AN ZIP
Phone # a
Authorized Agent
Project Location (County):
Street Address/State Road/Lot #(s)
Email Subdivision
i
City '^'.a ZIP
Affected ❑ CW W
PTA ❑ ES ❑ PTS Adj. Wtr. Body N 1 j-1 _Ti r Lac` '<. (natRnan�unk)
a /
AEC(s): ❑OEA IHA nuW SPIMA ❑PWS Closest Maj. W,.. Body
ORW: yes/no PNA: yes/no
Type of Project/Activity Uk/1D yX1iiL>La 01.4lF6e.Xl 70 14T1) A if x!7' 1,47Lfrj.
(Scale:(�,K"�. )
Shoreline Length_
Access Length _
Pier (clock) length
Fixed Platform(s) _
Floating
Finger
Total Platform area T7'? )r
Groin length/ft
Bulkhead/ Ripap length
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat amp
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
N
J
;
fli
I
4
/
Y
Y.
❑ 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 Na
Permit Officer's PRINTED Name
Signature -*Please read compliance statement on back of permit*"
Feels) Check p/Money Order
Signature
Issuing DatA Expiration bate

I

CERTIFIED MAIL • RETURN RECEIPT REQUESTED
DNISION OF COASTAL MANAGEMENT
ADJACENT RIPARIAN PROPERTY OWNER-NOTIFICATIONMIAIVER FORM
Name of Properly Owner.
Address of Property:
(Lot or Street #, Street or Road, City 8 County) /
Agent's Name ays - L a "ke N c ¢- Mailing Address: 1 2-,A6 --Z�5l =d-an �is�3
Agent's phone #: S a - 7� S = O / Q y r�ra .s c Ge
1 hereby certify that I own property adjacent to the above referenced property. The individual
applying for this permit has described to me as shown on the attached drawin the develo ment
they are proposing.
_< I have no objections to this proposal. I have objections to this proposal.
Ifyouhave objections to whatisbeingproposed, you mustnotifythe Division of Coastal Management
(DCM) In writing within f0 days of receipt of this notice. Correspondence should be mailed to 400
Commerce Ave., Morehead City, NC, 28557. DCM representatives can also be contacted at (252) 808-
2808. No response is considered the same as no oblection if you have been notified by Certified Mall,
WAIVER SECTION
I understand that a pier, dock, mooring pilings, 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 15' setback requirement.
I.do not wish to waive the 15' setback
(Pr erty Owner ]Information) L
Signature
�SQNZ `/afscc�
Print or Type Name
,?I 5*'dk gee�eresf C-k
Mailing Address
Awgf e'r /11 G 27rOI
CityRfatemp
`/1 633 0?3J
Telephone Number
7, 9- ZZ
Dote
Properly Owner Information)
Mint or Type Name ' T—
WK 27
Telephone
7�q_V
Date
Revised it'f 0" `-

i nerebv certify that I own property adjacent to
property located atG1T
/n (Addreee,
or Gcih;i2lcrsY'(e,� , in,
,Waterbodv)
The applicant has described to me. as shown below, the development proposed at the above
ti IW i have no objection to this proposal.
ha��oplections to this proposal.__.
DESCRIPTION ANDIOR DRAWING OF PROPOSED DEVELOPMENT
(indviCkAef Proposing development must fill in description below or attach a site drawing)
r pro O. eo� �9� /; �
l l �t3 �
s
51 X3j
S 1Lbr� I I �1 e
WkiVER SECTION
understand that a pier, dock, mooring pilings, breakwater. boathouse, lift, or groin must be se
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 clank below.)
do wish to waive the 15' setback requirement.
not wish to waive the 15' setback requirement.
ror; Jv-te? Into ation) 415-44
_
rK"
L/C!F
or type ive�/S/4'
0
�� = 336�y3z-�ZaB
(Revised 0 a2012,,

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit:
Mailing Address: �9
Phone Number: 7.T'o
Email Address:
I certify that I have authorized ��� -� E1
I s3 y�67
Agett Contractor 7 r
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary/for the following proposed development: 04'e A" - 'I�/' /
[Fe-`rl PolP
�t
f ve M
at my property located at Jq c
in_gr_ ref County.
l furthermore certify that / 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
ZS,✓,f F,-
q Title
Date
This certification is valid through =t �S

Eric Ellis
Marine Construction
DOCKS • SEAWALLS -BOAT LIFTS
DECKS & REPAIRS
Phone
Cell.252.342.6775
ME mom
■■ ■■M■
E■ _ -IM■■M
■■ . _ MI■■■
ME M!-ZMM
■Emumm
■■ _ MEMO
■■ NIMINIME
ME
ME IMO■O
ME M■■O
■■ M■■■
■■ tMEMEMIMEN
■■ ■■■M
■■ ■■■M
■■ ■■M■
■■ MEMO

�s�
ac(oss ��- �6 � �
W t o�-��
,GAS ;,�