Blakely, Dodie 88843C

ja°FcOAST41I ❑CAMA ❑ DREDGE & FILL N9 88843 A B c. D
y Previous permit
GENERAL PERMIT
T
❑New ❑Modification [:]Complete Reissue ❑Partial Reissue Date previous permit issued
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 cc.�._k )o
Address
City State %.._ ZIP
Phone # ( )
Email
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/noPNA: 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
Moratorium: n/a yes no
Site Photos: yes no
Riparian Waiver Attached: yes no
A building permit/zoning permit may be required by: �t���yf� l (:VZ< e�' ( r��.N �1 :A
s Dtf�c o r iQnr` �nxsrc� t ; ❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Condition
-. �_.�� t ,, :•,,+ . ❑ 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"
Permit Officer's PRINTED Name
Signature
Application Feels)
Check #/Money Order Issuing Date
Expiration Date

,1*jW 41NEICAMA El DREDGE & FILL N9 88843 A B C' D
4 = GENERAL PERMIT Previous permit
J 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 i 4-0 . I i ; ❑ Rules attached. ❑ General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name
Address
City State
Phone # ( )
Email
Affected ❑ CW ❑ EW ❑ PTA
AEC(s): ❑ OEA ❑ IHA ❑ UW
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 I (d
Avg distance offshore
Breakwater/Sill
Max distance/ length
Basin, channel
Cubic yards
Boat ramp
Boathouse/ Boatlift
Beach Bulldozing
Other
Authorized Agent ` k.
Project Location (County):
ZIP Street Address/State Road/Lot #(s)
Subdivision
City
ES ❑ PTS Adj. Wtr. Body
❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
P
nat/man/unk)
(Scale: i" = ( ,,, )
I i
SAV observed: yes no
Moratorium: n/a yes no
I
E
i
Site Photos: yes no
Riparian Waiver Attached: yes no t 1 r �
A building permit/zoning permit may be required by: ��t..• ' ,?f
❑ TAR/PAM/NEUSE/BUFFER (circle one)
Permit Conditions
❑ See note on back regarding River Basin rules
ElSee 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 Feels) Check #/Money Order Issuing Date Expiration Date

AGENT AUTHORIZATION FOR CAMA PERMIT APPLICATION
Name of Property Owner Requesting Permit: � o � f,� I L—'
Mailing Address: 1
Phone Number:
Email Address:
�" r
I certify that I have authorized i�- 5 � fps c:cj ' cf �i r
Agent / Contractor
to act on my behalf, for the purpose of applying for and obtaining all CAMA p . rmits
j_
necessary for the following proposed development:
at my property locate at
ine County.
1 furthermore certify that 1 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
�- I ck Q�
Print or Type Name /
0 VJ A)
Title
RECEIVE®
Date
This certification is valid through I I Clip

k.—., � _tj S
I hereby certify that I own property adjacent to
"7
property located at
�J (Waterbody)
P perty Owner)
Addr s, tot Block, Road, etc.) . N.C.
in
(Cityftown an or County)
the development proposed at the above
PP
The applicant has described to me, as shown below,
ij locatio
I have no objection to this proposal.
I have obiecti�rtso�i�is��op�sal-- - ----
--- DESCR1PT1ON AND1OR pRAWING OF PROPOSED DEVELOPMENT
` a1 osing development must tilt in description below or attach- a site drawing)
(Individual proposing. p
it o
t,
�ZPO
,,
I
)NAIvt=_R SEci1.0N .be set
boath--- I understand that a per, .dock, mooring pilings, breakwaanras°unless�wai ed'by met (If you
back a minimum distance of 15' from my area of ripa
k below.)
wish to waive the setback, you must initial the appropriate blan
I do wish to waive the 15' setback requirement.
_ I do not wish to waive the 15' setback requirement_
kAdjacant Pfoperty Own r In or ation)
('Property Owner Information)Pr
�i // iZ {3���G i Print or iflame
Print or Type Name �4mr fits
Mailing Address ! � �' a
Cii. /Sete ip
City/Stat.. 1p c
Telepho Numb(�cc
Telephone Number
Date RECF-7IVF
Dais
(Revised 6/18/g012)
')CM-IViHD CITY

T-
hereby cerbiv that 0 umn pr�a� ° adliau-001 le —
��i�►trt N�'aa+cary
Read meted a -.— C . --�
" (Address, Lo Block, Road, etc.) r' N.C.
(Waterbody) (city/Town and/or County
The applicant has described to me, as shown below, the development proposed at the above
locatio
I have no objection to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
ELO M a site drawing/
flrrdividual proposing development must fill in deseripbon be/
zri
001 f
I C.,
'�� a i
103
i t� es`r�tN�
gwlK��
WAIV=R SECTION _ rein must be set
_ I understand that a pierd of 15' fromn y a`rea of P anr=ess°unlesstwaved by me- (If you
back a minimum distance wish to wave the setback, you must initial the appropriate priate bkinkbelow.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15' setback requirement
(Adjacent Property n�er Infe�r�yration)
(property Owner Information} w7r
- - - - Sig" ere
SYgratur'e
print or Type Name
Print or Type Name ' = -- 0
►(0/�/ <<4�n7tif
l,!3 /�. � � Mailing Addrsss
rViailin Addressal
(Je ipd
Cify State/Z p 5— 1161 e♦ I W ZP d
- - Te" hone Nu ber
Telephone Number�t-
a,. Date
RECEAN C
Date (Revised 6110012)
KID 0 L! 2022
DCM-10HI) CIT°°'

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