88743C - Maybry, James

`°T41 FICAMA ❑ DREDGE & FILL A g D
c �9�
m Previous permit
GENERAL PERMIT
Date previous permit issued
F-1 New ❑ Modification F-] 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
(Scale:
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Moratorium: n/a yes no
Site Photos: yes n o
Riparian Waiver Attached: es no
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A building permit/zoning permit may be required by:
Permit Conditions
F—] TAR/PAM/NEUSE/BUFFER (circle one)
FSee note on back regarding River Basin rules
F-1 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 Fee(s)
Signature
Check #/Money Order Issuing Date
Expiration Date

®� C-oASr,t 040 88743 A B C D
&FICAMA F-1 DREDGE & FILL
3 Previous permit
z GENERAL PERMIT Date previous permit issued
New Modification P ❑ R 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 1-1 Rules attached. 1-1 General Permit Rules available at the following link: www.deq.nc.gov/CAMArules
Applicant Name Authorized Agent
Address Project Location (County):
City State ZIP Street Address/State Road/Lot #(s)
Phone # ( )
Email Subdivision
City ZIP
Affected 1-1 CW FIEW FIPTA FIES FIPTS Adj. Wtr. Body (nat/man/unk)
AEC(s): F10EA 1-1 IHA I I UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body
ORW: yes/no PNA: yes/no
Type of Project/ Activity
(Scale: )
Shoreline Length
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SAV observed: yes no 4 _ i 5 E»r ix:xx. x t s'
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Moratorium: n/a yes no a f # y y
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Site Photos: yes n o "+:'ry ,.., x:.�+.+ rv�.... ,:.
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A building permit/zoning permit may be required by:
Permit Conditions
F—] TAR/PAM/NEUSE/BUFFER (circle one)
F-1 See note on back regarding River Basin rules
F-1 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

N FOR CAMA PERMIT APPLICATION
a
IV a
Narne of Property Owner Requesting Permit:
Mailing Address:
')0C)
J_
Phone Number:
Email Address:
o-'ni a
I certify that I have authorized 0 n �tul"6
to act on my behalf, for the purpose of applying for and obtaining all CAMA permits
necessary for the following proposed development:
at my property located �14
in County.
ve
f furthermore certify that I 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-. i��� �,i
100A
ni
'00
c7 Signature
Print or Type Name
L9
Title
Date
This certification is valid through J

ADJACENTRJPL DMSION OF COASTAL MANAGMENT
.ARM PRO PERTY -OWNER-NOTIFICAIIOKIWAIVER- FORM -
Name of pmperty ownar
A2!-
Addrfts of propqrty.
Al
Lotor
-Street SIree or Road Ck County)
Agent's Name
Malling Address: -Y,*,(4jzf
Agent's
I hereby cedify that I own property adjacent to the above referenoed property, The *ndMdual
appyng for this Permit has de3cdbed to me as Shown on ft atached drawing the de ent
th0Y are Proposing.
I have no objectioUs to propoW.
I htye objectons to tis proposal."
'you t7ave-ObjOctOns to What Is being proposed, youmustno&yfhe DMslon ofCoasW Management
(DCAV in �v?Vng Whhfn 10 days of recejp� of this notf•
oo. Correspondence should be malled to 400
COMMer-ce A ve,.T Morehead City, NC, 28567, DC)W representWyes can also be contacted &t(2-52) 808-
2808, No respo
ns-s,. the sane w no ob.iect f*bn if ou tu ve bow iyotfffed b Mier! Wall,
WAJVERSECTION
I understand that a pier, dock, M00fing pilings, breakwater, boathouse, lif� or groin must be set
back a minimum distance of 16from my area of ripArian access unless waivsd by me. (ff you
wish to waive the setba6k, you must initial the appropriate Wnk below.)
I do wish to waive the 151 ethaQK
jequiremeA
I do not Wsh to waive the 15'setback requirement,
(Property Owner Information)
igrZt0we
(- --
Prfnt or Type Name
MaNng Addfass
s�-�� A
le
ciwtatalzip
Telephone Number
Date
(Adjacr,t Property 0wrier information)
.....gn9tve
doo
Prf;� or Type Name
YOilng A ws
7Y�76
f elephone NUm ber
4� 1 2
Devised 6/18/20

riaLi ivyAi i- - rxu.
DIVISION OF COASTAL MARAGEMENT
AJDJA0ENT-RJPARIAN PROPEF:ZTY OWN EIR-NEYTIFICATIONIWAIVER- FORM
Name of Property owner.
Address of Property
io
(Lot or Street #, Street or Road, cqy County)
Agents Nara® _J
Mailing Addre
Aaents phone
I hereby certify that own property ad-acent to the above referan(Cled pr,,:,�perty-
i the deveiOpment
app�4ng for this It has desoribed to me as shown ori the attached drawn
is, Perm*
they are. proposing.
ARM--
ha7ie, Y
1 Ira CNe0q_i0,RS to tE 5 T Op 0S
B"JaS tO t�2s PTODC)s"5d, Y
1. 1
if you have objections to what is being proposed, you must notifYthe Div'ision of Coastai Man8g,mentI t 0
(D CM) ir7wrfting within 10 days of receipt of this notice, kr_%.orresponcfence should d be malled o 4 1 0
COMM or-ce Ave., Morehead City, NO, 2855"?, D-CM representative, can 31so be
or,facted at (252) 308-
lWa
169808, N0-resPonse is considered the same as -no obiectfon I notified by Celtifed il,
WAIVER SECTION
,
I urderz;tand that 3 pler, Jock, r7,,,,00r'1r1,9 pilitr,-,as, breakwa�erl patniol b�ste:::;. 'ift, Or ]rcin be"e,
back a mirimum dtstan(,-e_ (.,�f 1 from n-)y area rof ripanar, cess unlessv, On Mish to I *wa"ve, the e setback. YOU MUSt initial the apt h s p P, are �t2r-,K 3elOW
q
I do wish flo 'h)a've the I setbaq re.
I do not �jvish to wa;lve 'the set' a
(Property Owner Information)
t
.Orl'n
t or Tr'
,iVailing AdYea,--
/*
Tp/zi N
-)formation)
kM7'ent ProWpeerrt, w11
y
A
VOW,
Pr,v _YPe 114ame
;7
Va '1,-n;C1 A �diress
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