86780A_Whitley, Bruce_20220914

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❑CAMA El DREDGE 86780 A B C
DREDGE & FILL ��'
'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.dgq.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
(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 i
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 ❑ 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 Feels)
Signature
Check #/Money Order Issuing Date
Expiration Date

AGENT AUTHORIZATION FORM FOR PERMIT APPLICATIONS
Name of Property Owner Applying for Permit: Br j(P d- f OU &nr u W h ille
Mailing address: y q Rni-t & I1), Pl y fir, yr,
Wind -,,or., ►U G Z 79 83
Telephone Number: 7 5 7- 6,30- 8220
I certify that 1 have authorized (-,cn cra i Min irnonc c, Tn r.. (agent/contractor),
Robot Soknders
to act on my behalf, for the purpose of applying and obtaining all CAMA permits
necessary for the proposed development of bu I K hcrid, rc.Q IOCC e f•
at my property located at y h I► v ri N G 2 7 q a3
This certification is valid through (date).
(Property Owner Information)
1nature
.gruc� W . Lv h l+Ic`I
r�urtncv L. Wh►tic,4
Print or Type Name
Title, co. owner or trustee for property
gI13)ZZ
Date
_ 757 - 4,30- 39Z0
Telephone Number
wh,fIcv-FDureoZcon ► 1. Corn
Email AddresW
RECEIVED
SEP 1 4 2022
DcM-EC

---FELYZINCERMMRIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to &(urc, YV +-COUt+nCV I - W h i+IC4 I
(Name of Property Owner)
property located at y y L4 -86+C ,Dr I r o
(Address, Lot, Block, Road, etc.)
on Ibemarla , N.C.
�q 0 und. , in h/ lndsor �� G ,
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locatign.
I have no objection to this proposal.
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)
L7
S e P 0 1 2022
DCM-EC
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 requirement.
ro rty Qw er Ration)
oC
Signature
Print or Type Name
4 4 y BQ tGhe �Di &�I, ,Do YC-Z
Mailing Address
hllnk;nr-, N6 2798.3
City/State/Zip
757- 63P 8920
Telephone Number
5 I V22
Date
(Ad-acent Property Owner Information)
Signature
CLh
Print or T Pe Name
yy2 &khelor 6014 Drive,_
Marling ddress
winds -or , �JC Q-A 3
City/State/Zip
?t;2Z -38
Tele hone nnNu��mber
Q `LI_
Date
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to,19I0c -F 6114hry W h► +Itti Is
(Name of Property Ow er)
property located at q q '4 baitht loll Boy D r
(Address, Lot, Block, Road, etc.)
on Ahrrhadc, Sour) in Wind&Qr ,N.C.
(Waterbody) (CitylTown and/or County)
The applicant has described to me, as shown below, the development proposed at the above
locat, n.
�T i have no objection to this proposal.
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)
Sr P 0 1 2022
DCM -EC
WAIVER SECTION
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 requirement.
Property Owner Information)
Signature
-ucc. d- (-Qb rfYicv W h r±ey
Print or Type Name
ilgy SakheIDr Sav ,Drivt,
Mailing Address
W�nolS�r , fVG 71 33
City/State i
7s7 - 63D _ 8920
Telephone Number
Mau 9. 2.02-2
Date
(Adjacent Property Owner Information)
Ali,
'
Telephone Number
Date
CM
rr3
(Revised 611812012)

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to \ r�--t— � �-ULr� 9 V h +�'t 4 I
L (Na of ProTr-
(Address,rty ner)
property located at ��� QG UkUr- ��
Lot, Block, Road, etc.)
on N`�trr-N krL in u - N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
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)
S i P 0 1 2022
I
WANER 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 requirement.
(Property Owner Information) (Ad' cent ro rty r Information)
—PAM.-► LJ lAi k'^
L tJ !A/M 1U/ of Ji�
Signature Si re
NLILr, 1n/, r t!°nu/Mc L. ln/h,'f4 AJv` `
Print or Type Name Pont or Type m
!f 9'1 8akir v &� , .G146 -� r t
Mailing Address Mailing Address
Win G Z77&3 �n
City/State&ip City/Stat ip
7_s 7 - 630 - 02a jam.- :1 ?,l
Telephone Number Telephone Number
.519/Z2- t - i G
Date Date
(Revised 611812012)

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