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86830A - Clemens, Carolyn
`°"r",&❑CAMA ❑ DREDGE & FILL N° 86830 A B C D 3 4 GENERAL PERMIT Previous permit 0 Date previous permit issued D 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 Q Rules attached. Q General Permit Rules available at the following link: www.deq.nc.gov/CAMArules Applicant Name Address City State Phone # (_ ) Email Authorized Agent Project Location (County): ZIP Street Address/State Road/Lot #(s) Subdivision City ZIP Affected ❑ CW ❑ EW ❑ PTA ❑ ES 0 PTS Adj. Wtr. Body (nat/ffWunk) AEC(s): ❑ OEA ❑ IHA ❑ UW ❑ SPIMA ❑ PWS Closest Maj. Wtr. Body 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 Avg distancg offshore Breakwater/Sill Max distance/ length Basin, channel Cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing Other SAV observed: yes 4 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 (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 Signature "Please read compliance statement on back of permit" Signature Application Feels) Check #/Money Order Issuing Date Expiration Date N.C. DIVISION OF COASTAL MANAGEMENT AGENT AUTHORIZATION FORM Date Name of Property Owner Applying for Permit: Mailing Address: /3/ - � ��e� I certify that I have authorized (agent) -51w/ / l 9'1-oAller 5 to act on my behalf, for the purpose of applying for and obtaining all CAMA Permits necessary to install or construct (activity) 7� at (my property located at) /3 ( -61(- /33 /,,,I/ This certification is valid tbru (date) Property O"er Sigpature Dade ■ Complete Items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Illllillllll !IIIIIIiIIi IIIIIIIII I IIIIIIIIII 9590 9402 5869 0038 1166 41 2. Articles Ni imin— (Trnncfar from .aprvira lnha/1 7020 2450 0002 3104 El Agent ❑ Addre B. Received by (Printed Name) C. rte[ D. Is delivery addross different from ite mI?? If YES, enter delivery address below: Cj No 3. Service Type ❑ Priority Mail Expresso ❑ Adult Signature O Registered MalITIA • Adult Signature Restricted Delivery ❑ Registered Mail Restrlcte G Certified MaHO Delivery © Certified Mail Restricted Delivery ❑ Return Receipt for El Collect on Delivery Merchandise J Collect on Delivery Restr'cted Delivery ❑ Signature ConfirmationTm 0 Signature Confirmation 4918 Restricted Delivery Restricted Delivery PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt _�.�! =,1 ._i!_. ► ia•.i=ill t.A, i►!:Ilt: •ll'a_ _ 1.•.. i►•.: On in Q� N.C. lM► iod!I) bwn afidioc COUW) Agents Name Maing p,ddness: _ /d 9611( Agews phone#- 5-q-7- 0 7q-7 7� 5 7 H&%hehas desc rind tO me as atxm belowthe developmenthdshe is P rig ate b,,fi., and t have no objections fo the proposal. n w �► of ® 9PIEL �r �PmP� q>�sti>� fir, d 1oe babes Pra ', a sfe dkowino -7[\ &1461�-al o��Loroa�rM.�ao►It fQV of�arlE d�efn�affift MI -����"Oe be,r Zz;SL 3M SMEmbeM O[AMCs27sael DC/lip canabobeccaftceedatalim2ss- 390i_ llto �espar�eis cor ddMusa aseo a0 ocdw M[hae been DOMW Mg (Properly O+nrwac iaion) Pfi1tQ' Ilse �-, 1�? ewy Zzii'l/c Z i�1AplienA lllulribsr/� � U. (AdJaMt Properly OWOW hOwnud:gn) �i�Nphaa /F� Add►ess Dot PAvi!XWJwL2M7 ^ �� : � t (: « w y�� �� z� <_� � � � . . ., . x . -� r��� « 2 a:��<� � t ?� dw§ � ; � 2\< «� ?<\� » © y� \ ..� � ©. w .: � :. <� , � \� . .� . . .a>\xz� z . �.,� v:7Rd«� a 2:«w° . .�.� /\ . :� � � v, ,« :?, . � «�» « .� � «a